Medical Students can handle the truth, Academics should be more open with it

Medical School is rough.  Fortunately there is a recent movement to make Medical Education more humane.  The movement to bring humanity, ethics, and love back into the molding of our future physicians is crucial.  Personally, I felt my medical school was on the forefront of this push.  Perhaps it was because we had Jesuit Priests for Attendings and the institution’s motto of “We also treat the human spirit” was also filtered into the treatment of students.  Whether it was something about myself or my medical school, I was fortunate to never experience the depression, competitive urges, burnout and isolation that is so prevalent during American medical school years.

But there is an underlying and hidden truth that is never spoken about, or at least wasn’t to me, in Medical School.  As students we are warned how tough medical school is and furthermore how absolutely draining residency is.  When we’re in the thick of either in even the most uplifting programs and schools, we are monitored for burnout, offered services to prevent it, and given support in ways students and residents of the 20th century never were.  More frequently now, we are prepared for these harsh realities  But what we’re not told, ever, is that even if and when we make it through medical school and residency/fellowship to attending physicians we may well find it’s still not greener on the other side.  We may still first experience burnout when we’re supposed to be summitting our Everest Mountain of medical training.  As many mountain climbers will tell you, often the way down from the peak is just as hard if not harder than the climb up.

After having spent a year in private practice, a year in Academia, and now venturing out on my own, I wonder what it is or why we aren’t more open about it?  Perhaps it’s because many lifelong Academicians are indeed sheltered from much of the non-doctoring paperwork and data entry that private physicians are forced to do.  That said, Academia is still full of challenges unique to itself.  Getting grants, getting published, tenure, institutional and field specific sexism……to name a few.  As Medical Students, it’s completely hit or miss if you’re exposed to a mentor or physician in private practice.  You may get lucky in your 1st year Patient Centered Medicine group and get a group leader who is actually a private doc volunteering their time, but it’s unlikely.  And even so, we docs are told to keep quiet about our struggles for fear of turning people away from the profession.

Maybe it’s just my personality.  I don’t like surprises, and I have found over and over that if I am prepared for something ahead of time (whether it be emotional stress or physical) that I am far more able to cope with it when and if it happens.  I don’t think however this is unique to me.  As a physician, I have found my patients are far more able to handle hiccups or side effects if I appropriately forewarn them to anticipate them, normalize their feelings, counsel on what they do if those unpleasantries happen, and encourage them to call me if they’re concerned.  Turns out, I get less calls in the middle of the night and my patients feel empowered, and less alone.  I’ve also been a patient and I find the same is true.

It was the amazing mentors in Family Medicine at my medical school that made me jump from a path intent on Internal Medicine then Geriatrics to doing Family Medicine as my route to Geriatrics.  Yet, I wish they had forewarned me that my potential salary and earnings as a Geriatrician would be lower in some places just because I was Family Med trained instead of Internal Med trained.  I was also never informed of the heavy burden of Maintenance of Certification testing and modules that Family Medicine would make me do that are irrelevant to the Geriatric population.  I wish some of the female mentors would have given me the heads up on the truth, that sexism in medicine, even fields like family medicine, is alive and well.  Had they, perhaps I would not have felt so affronted and demoralized when I first experienced it as a new attending.  I wish I had known how prevalent burnout is among attendings (of all fields) so that when I experienced it for the first time in what I thought would be my dream job, I wouldn’t have felt so alone.  I wish I had known that those of us in time-based fields (Geriatrics) are actually punished for taking time for and with our patients.

To Medical Educators and those in Academia:  Consider bringing in outside private docs as lecturers.  Bring in diverse physicians who will speak truth and bring transparency.  It will help Medical Students trust that the profession they are bleeding for is trying to be honest with them.  To Medical Students:  Know yourself early and seek help often.  Reach out to anyone willing, and be prepared for the reality that, even if you make it through residency and med school without a hitch, you may find yourself still struggling to find meaning in your vocation in this American Healthcare System.  But also know this:  You are not alone, it’s normal and you will have legitimate cause if you feel that way.  It’s not something wrong with you.  In fact, you are probably a physician that cares if you’re negatively affected by the system.  And most importantly, there is hope for a better future for medicine for both ourselves and our patients.

 

 

 

 

 

Subliminal Sexism in Medicine

For the most part, the sexism in medicine is not subliminal at all.  It’s quite overt.  However, unless you’re a female physician, you probably are unaware that it’s still an ever-present reality for us.  I do want to note that there are very good men out there who are trying their best to be advocates for equality in our field even though they can not fully appreciate the female physician plight.  My father is one.  My husband, an Anesthesiologist, is one.  The male physician-entrepreneur I met with last week to discuss a partnership in my new solo practice with his clinic system is one.  These men are the “He’s for She’s” of medicine.  And yet, the hurdles are massive even once we women have finally made it to attending status.

Examples of overt sexism abound.  As this article notes, the pay discrepancy for the exact same job and hours worked is blatant (>$100,000 difference).  Physicians in specialties such as ER and Anesthesia may not appreciate this, as their shifts might be salaried per hour.  However in fields that require a lot of non face-to-face patient care and fields which weigh “productivity” aka patient face-to-face volume and turnover heavily in the pay, women are often paid significantly less.  I’d contend it’s because in many non-procedural fields females more often take the time necessary for patients despite the sacrifice to their productivity earnings.  We women, frankly, tend to care more about the patient than our paycheck.  And yes, there is evidence to back this up.  A Harvard study released in JAMA this year showed conclusively that elderly patients admitted to the hospital had lower death rates and readmission rates when treated by female internists compared to their male counterparts.  While the numbers are overt, the subliminal sexism is written into the RVU methods of physician reimbursement.  Those who care enough to take the time to do the job well inevitably get punished financially.

Let’s forget about numbers.  There is overt sexism we women experience daily in how we are addressed and spoken to.  Frankly, a man would never tolerate without a complete fit the words and tones I have had to take from coworkers, bosses, and patients alike.  Last week I had a meeting with a hospital system in my town who has been trying to get me to agree to work for them for months without retainer.  We finally met and I told them about starting my own solo-practice instead of employment, but also to discuss how I’d be happy to assist with medical directorship for their SNFist program and inpatient Geriatric care improvements.  The female care manager told me how she didn’t think what I could offer was necessary from a physician and the male physician said,”I just don’t think you’re going to get anyone to pay for your care out of pocket when it’s something medicare covers” (I’m opting out of medicare).  I don’t think they’re aware of how this came off.  What they were trying to communicate is that they aren’t looking for a medical director at this time and they are concerned for my financial viability solo.  That’s what they would have said to me if I were a man.  Never would they have insinuated that my expertise as a physician and Geriatrician, something unique to this community, were not wanted or needed (it actually very much is), or that my care was comparable to the the care provided by the non-physician providers who go to the nursing homes and assisted living facilities here (it’s not comparable, my care is better because I am trained at a much higher level to care for this vulnerable population).  No, Medicare doesn’t actually cover the quality of care I provide.  So this is blatant.  This kind of thing also happens routinely to female physicians of every specialty.

Let’s get to the truly subliminal content.

My husband opened my American Academy of Family Physicians CME advertisement in the mail and brought to my attention the fascinating pictures.  Here are 6 of the 8 pictures, including all of the pictures featuring women.

I guess I don’t know if these truly are subliminal because it was my husband who pointed out to me how sexist this seemed.  He’s not one to catch subtlety.  The pamphlet has a ratio of men to women pics of 6:2.  So the numbers already don’t reflect the reality of family medicine.  However, in the entire pamphlet, there are only pictures showing men as smiling, engaging physicians/leaders/teachers.  The women pictured are either facing away or with an expression that says, “I am a passive recipient, incapable of worthwhile thoughts of my own or engaging discussion.”  Then there is the woman staring at the painful computer CME module with the pen in her mouth.  Is she a secretary enthralled by data entry?  Why is there not a single picture that depicts a woman physician smiling, engaged, like someone you would want to talk with, or care for you, or capable of teaching you?  And this is not a testosterone driven surgical specialty.  This is family medicine people!  Where women are actually more prevalent in the field!  Also, it’s not like the pictures are showcasing the keynote speakers (although that is something that is also far too male-dominated).  It’s advertising how the AAFP envisions its audience.  Even the AAFP does not view women as equally capable of being physicians, leaders, and teachers.  Their marketing tells us so.

Still today in medicine, even in the fields full of women, the message sent is that men lead in education, discussion, and patient care.  But truly, it’s the women making the most impact in time-based fields and giving our heart and souls to do so.  We are just as capable, just as engaging, and it’s time to demand that our fields recognize this before we continue to break our backs in the trenches.

 

 

“Sorry, I Ain’t Sorry”

At first listen, Beyonce’s Lemonade album seems to purely be about her, and her relationship with herself and her husband.  However, as I’ve had it literally on replay for the last week in the midst of facing a major Professional decision, I can’t help but feel it’s so much more for women.  For me, it can help me find the confidence, self-love and inner strength to know that I really don’t need a man, or an organization run by men, to be successful and to do what only I can do.

I am still in the midst of the decision.  Do I accept an employed job as the only Geriatrician in an entire hospital system run  on a fundamentally corrupt physician payment model and subsequently poor patient care model just for the salary?  Or, do I do what I know will make me most happy and opt-out of Medicare and start my own practice doing medicine my way (the right way……where I spend time with patients and families, listen, counsel, diagnose, and walk with) despite the likely low financial return?  If anyone’s reading this, they’re probably thinking, “This seems obvious…….do what will make you happy, go for option number 2.”  I wish it were that simple.

I am a female caregiver through and through.  I became a wife and mother right as I became a physician.  I am terrible at putting myself first, even when it’s essential.  Part of taking care of oneself is knowing how to and when to avoid abusive relationships.  It’s from learning from our past mistakes.  Whether it’s with spouses, friends, employers, businesses, or any type of relationship, knowing one’s strengths and failings is crucial.  Often it takes making the mistakes first to learn our own strengths and weaknesses.

My strengths are these.  I’m smart, and also extremely caring.  I empathize truly and deeply.  I do feel the pain of my patients and their families, and the joys too.  I’ve been a patient also, so I don’t have to work too hard to put myself in the shoes of my patients.  I’m honest and transparent.  Authentic perhaps?  I can’t lie, nor can I fake things.  This leads me to my weaknesses:  I am incapable of being “political”.  If I see something that isn’t right, I can’t keep my mouth shut to save-face for someone else.  When I try, I become testy.  I don’t suffer foolishness among colleagues well at all.  I will fight for my patients and doing what is right for them at all costs…….usually at the cost of reimbursements from Medicare.  I am intensely bothered by the difference in how female physicians (myself included) and male physicians are treated by those we care for, work with and among, and are employed by.  And I am unlikely to get over that.

Where is this exercise going and why is Beyonce’s “Sorry” the current song-de-jour on repeat?  Despite the above, I still have this nagging voice telling me I should take the job with the hospital system.  It’s the voice of fear, of feeling bad for saying no to them, of repeated patterns of delving into a relationship for security and not for what is right for me, and of the problematic thinking on my part that constant self-sacrifice is a good thing.  Here is what I know.  The job will not make me happy.  It would allow me to stay in Medicare, but in a very toxic practice environment.  It won’t afford me the flexibility I want to be the best mom and doctor I can be.  I know I’m unlikely to last in that environment as I can’t keep my mouth shut about things that are wrong but I also don’t like pissing off all my colleagues.  I don’t like that kind of competition.  For a geriatrician, opting out of medicare is such a huge deal.  Telling my future patients that I won’t take their free insurance (because Medicare is a narcissistic regulator of physicians) is scary, even when it allows me to give them better quality of care.

So, I have been gearing myself up for the moment when I finally make the right choice for me.  This hospital system has been literally leading me on for months now.  They are apparently finally going to show me the proposed contract and letter of intent soon.  And I want to be ready to do what is right for me.  I don’t want to close any doors prematurely, so I’m waiting to see the contract before I do anything definitive.  However, based on their behavior thus far (poor communication, asking me to wait on them without any guarantees or retainers, clear resistance from other physicians I’d be working with), I have no reason to believe that this is a group or organization I want to be part of, particularly when I’d be one of the only female physicians doing what they’re asking me to do.  Just like people, organizations don’t change unless they see the need for it and seek it out themselves.  Medicare and many of the businesses of healthcare are indeed narcissistic.  While many good people work for and within them, the overall company culture is one that is incapable of empathizing with those who work for it while simultaneously being hyper-sensitive and reactionary due to a fragile sense of self (or lack of any true mission beyond money making).  These are the kind of relationships that are so trying.

I don’t know if I’m ready yet.  However, it’s not a matter of if, just when.  And when I finally am ready, I will serenade Medicare with Beyonce’s words, “Sorry, I ain’t sorry…….middle fingers up, put em hands hi.  Wave em in his face, tell him boy bye……I don’t feel bad about it, it’s exactly what you get, stop interrupting my grinding.”  Instead of a boy, it’s Medicare in my mind, and the health systems.  And my “grinding” is my doctoring.  Because I am one bad-ass physician, and just about every patient I’ve ever had will tell you that.  Medicare, regulators, politics and those who just care more about the Benjamins have been interrupting my doctoring…..and I’m sick of it.  And I ain’t sorry when I finally leave them.

 

This Geriatrician wants single-payer universal coverage, but expanding Medicare in its current form is not a good idea.

Thankfully, the GOP did not pass Paul Ryan’s unfortunate excuse for a repeal and replace bill for Obamacare.  Immediately after, I saw a headline hopefully concluding, “Medicare for all may be next.”  In Medicare’s current form, this would be devastating for the health of America.  I am a young Geriatrician, I know a heck of a lot about Medicare.  Most people don’t.  They just see it as a great perk of turning 65 in America and the social healthcare we offer to elderly and disabled.  I did too, until I became a physician who only sees Medicare patients.

Medicare originated in 1966 in recognition that we needed to do a better job as a nation at caring for our aging and disabled who could not get employer provided insurance.  In 1989 the Omnibus Budget Reconciliation Act established a fee schedule for Medicare payments.  This assigns “Relative Value Units” or RVU’s to everything we do for our patients in medicine.  The formula that determines RVU’s disproportionately favors procedural care to time-based care.  Essentially, Medicare pays and incentivizes Medical Providers to do things to patients and actually dis-incentivizes physicians from taking their time with patients.  If you wonder why the doctor-patient relationship is not doing well right now, wonder no more.  Trust takes time.  Even family doctors who take Medicare have to turn their practice into a patient or low-risk procedure mill to make ends meat.  Medicare will pay a physician between 70-80$ to freeze off a wart, a procedure that takes about 2 min  to do, and 1 minute to document in an EMR.  In contrast, I can spend an hour with an elderly patient with multiple complicated issues, addressing their concerns, reviewing and adjusting their many medications, and coming up with a plan and then having to take 30 minutes later to document what happened and get paid essentially the same amount (about 80$) had I just spent 3 minutes removing a wart and sending them out the door.  Is it any wonder that Geriatrics is a dying field?

There was a time, however, when despite the RVU working against physicians who primarily use their time and knowledge to diagnose and care for patients, physicians still did it because they could make a decent living while being fulfilled in the solace they were helping.  But times have changed.  My father is a Geriatrician.  He went to the equivalent of his state medical school from 1978-1982 for $5,000 a year in tuition.  No loans needed.  Had I gone to my state school (same as his) from 2006-2010, in-state tuition would have been 25,000$ per year.  I came out of medical school with roughly 200,000$ in debt at anywhere from 7 to 15% interest that accrues quarterly, and I’m lucky.  The physicians today in their 50ies – 70ies truly can not comprehend the financial sacrifice new physicians make when committing to primary care today.  But, it’s not all about the money.  There is far more paperwork, tracking of useless data, non-patient care related work that we are forced to do that merely detracts from the already limited time we have to see patients and develop a relationship.  And we have to deal with this burden from day 1 of our practicing lives.  Many of the older docs have moved into administrative roles yet still remember clinical practice how they experienced it.  In turn, they create detrimental policies and regulations to feed metrics in the name of “quality” all while being clueless as to what it is like to actually treat patients in the modern era.

Some might argue that by expanding medicare for all, it would cover less complicated patients so the current model shouldn’t be a problem.  I’d also beg to differ on that one.  Doing things to people, even prescribing medications, is dangerous and should not be taken for granted.  Medicare still incentivizes doing more invasive things for the least complicated patients.  Say we expand it to everyone, and a 22 year old comes in with the cough she’s had for 5 days.  It’s viral.  Viruses are the worst.  There is no treatment other than time and support.  But convincing patients of this when they know I have the power to prescribe a Z-pack and they always get better on the Z-pack (20% of effect of any treatment is placebo) takes a long empathetic conversation.  Ya know what is quick and easier?  You got it, just writing the darn script and moving on to the next person so I can get paid more.  And then we have massive bacterial resistance to azithromycin (the Z-pack) and C. diff is on the rise.

The numbers on all accounts point to the reality that Medicare’s RVU system of paying providers is causing worse outcomes, is unsustainable in cost, and is not attracting young talented physicians to the most needed primary care fields.  I wonder how many of the new family docs will inevitably succumb to 10 min visits with high procedures and more referrals to costly specialists or ultimately opt-out of medicare and insurance for direct-primary-care?  Medicare spent 650 billion dollars in 2015.  An underestimate suggests 200 billion dollars (or 30%) was spent on beneficiaries in their final year of life.  That means we as a medical community, despite probably knowing the patients were dying, kept doing procedures and tests and more treatments to people because that is what we are paid to do.  American culture indoctrinates us that death is optional.  It’s really not.  But why would a physician take the time explain to a patient and family the reality of their situation, a conversation that is exhausting and challenging for everyone involved, when they are paid about 5x more to just offer another procedure or test and move on?  And then we spend billions of dollars doing things while ignoring the essentials that require time, and we get the worst outcomes.   The current Medicare, if expanded to all, will only exacerbate the costly failures of our current system.  A single-payer universal coverage system?  Yes, please!  But not Medicare as we know it.  Heed the Geriatricians now while you still can.  We’re the most needed physician endangered species.

 

 

 

 

 

An Open Letter to the self-proclaimed “Professional Truth Sayer”, Matt Walsh

Dear Matt Walsh, Professional Truth Sayer,

I’m a devout Catholic.  Based on everything I read of yours recently I feel like I have to qualify that (because your writing style routinely starts with false labels and generalizations and when people point this out you only then clarify the very specific audience you are apparently speaking to).  My unabashedly liberal sister called me randomly, knowing that I had at one time (I think when you first started) liked a post or 2 of yours, and  wondered if I’d read anything of yours recently and also wondered if I’d consider writing to you on behalf of moderation (she knows we don’t agree on a lot, she also knows I’m an Independent).  My initial gut-feeling was……it’s not worth my time, nothing I write will change the mind of the self-professed professional truth sayer.  Then I got into a disagreement with my sister regarding some of the things that I disagree with on the “liberal” side (like the emphasis on transgender issues and treating two different issues (sexuality and gender) as one issue).  I realized something:  This likely won’t change you or your mind.  However, extremes drive extremes, and it is high time moderates, independents, people who are open to other viewpoints and capable of empathy for someone even different from themselves, and who are good at seeing the bigger picture start speaking out and louder than the extremists.  So here it is, read if you’d like.

I’m still debating how to approach addressing you.  Should I take the loving stance and appeal to reason, shared values, and shared Faith?  Or should I take the approach that is my instinct after reading your words that are clearly meant to ignite rage, fear, bitterness and just pick a fight?  I get the sense you like a good quarrel, but I will do my best to stick with the first approach.  I will probably fail.

The recent post which brought your blog back to my attention by my liberal sister was the one about Trump’s refugee and immigration policies and Christians.  This one..  Indeed, your writing style and choice of words implies that to be against the recent Executive Order banning even already vetted refugee and immigrants from 7 predominantly Muslim countries (and fascinatingly not any of the countries who bred the most horrific terror attacks on US soil to date in which Trump likely has business dealings wsj article) is to be a secular liberal Instalogian who views the Bible only in terms of childish fairy tales until they want to use it against you and all conservatives like you.  It’s obviously been pointed out to you that many Christians and Catholics (including many of the Bishops of the US) also believe that this particular policy on immigration (to clarify for you Matt, they are not saying ALL immigration laws are inherently immoral as you suggest they claim in your blog) is antithetical, even as policy for a nation, to Christ’s teachings.  Still, you continue to write in a way that is clearly meant to spread false-information while also making fellow conservative Christians feel victimized by everyone.  Have you really heard that your faith requires you to “advocate for the immediate admission of illegal aliens and un-vetted refugees from terror hot spots?”  I get the sense you fudged the wording a tad because not even my Trump-voting friends here in Lubbock TX think those of us who opposed the ban are saying that.  Most realize that those who are allowed in as refugees already go through an extreme-vetting process to get here (yup, there are already laws in place that do not single out predominantly Muslim countries meant to stringently vet immigrants and refugees in order to protect our country and its borders).  And those who oppose the wall don’t all feel we should open our borders to everyone, but rather that we should explore other options of handling undocumented immigrants who manage to survive the exodus from their own country to get here.  I get the sense your words are intentionally misleading.  Oh and I have literally NEVER heard anyone, left, right or middle, suggest, “You can’t be a real Christian unless you’re an advocate for open borders and unfettered immigration. National security and sovereignty are heresies!”  Even the blog post you linked was not saying that.  That may have been what you in your primed for outrage stance heard, but it hasn’t been said by anyone ever as an argument or even a cry of outrage because it’s nuts.  So why suggest that it has?  What are you hoping to achieve?  I’d say almost every American who cares that America as a whole (and not just the white Christian sect of the country) succeeds for the sake of everyone having equal dignity in life agrees that immigration is an issue, we do need to protect ourselves (hence why we don’t just let anyone in), our open Southern border makes things complicated, and there may be a multitude of ways for us, as a Nation, to reach our common goals while still upholding our Constitution in it’s entirety, promoting Religious Liberty and protecting our Democratic (I mean as a democracy, not “Liberal”) ideals.

Ok so that was to address the inflammatory and compassionless tone of your writing.  This would be far too long to address every single scriptural argument you proceeded to write in your blog.  I’ll focus on a few that stood out and then quote a true theologian.  Also, I’m only going to address concepts you use that are from the Gospels because ultimately those are the most accurate accounts of what Jesus wanted to impart upon us (can we agree on that?).  First, I don’t agree completely with the uber-literal interpretation that Jesus wanted us to only focus on those in our immediate land based proximity.  Technically if He did though, Mexico shares a land border with us so you could understand then how Mexicans in the north are in the proximity and true neighbors of Americans in the south?  With technology today, the internet, etc we see things and know things about what goes on in our shared world and know that every person is within our vicinity as humans.  Even so, many Christians (and Muslims, and seculars, and every other type of persons) here in the USA have professions that give them the honor but also the reality in working one on one with the least of us in our proximity, and then recognize that policy is one of the most effective ways to help them, and vote accordingly.  The majority I know who feel compelled to do something about the refugee crisis not only donate to the causes to help, but also offer their homes and clothes to help…….problem is, with the recent EO the already vetted refugees can’t get to our homes.  You pretty much accused people who vote for social policies of lacking personal charity with your clothing analogy.  Is this how you spread the truth of the Gospels in love?  The majority of people I know who advocate for better social policies due so, not for clothing assistance, but for basic healthcare needs (excluding abortion obviously……again feel like I have to clarify because you’ll find any way to attack possible) met for all Americans.  Even though I’m a physician and bleed my time and love for my patients, I can’t treat everyone nor can I give enough away in my own resources to really make a dent in the care for those who most need it.  However, I can petition legislatures for a basic single-payer state funded healthcare system knowing full well that the heaviest taxes will fall on my shoulders to support that (wouldn’t those be considered my own resources?) and that is another way of giving to promote human dignity for my fellow Americans.

Ok Matt, I’ll wrap it up.  Are you still reading?  I can understand if you’ve stopped, I had a really hard time getting through your stuff of late.  You ended your blog post with this, “And if you feel that Scripture compels conservatives to adopt a left wing approach to this issue — even as you openly deny the validity of Scripture and mock those who read it — I would suggest you find a better argument entirely.”  No Matt, most people, Christians and non-Christians alike, who oppose the recent Executive Order do not mock Scripture or those who read it.  Rather they oppose the Executive Order based on it’s shortcomings and their shared understanding of the founding principles of our country and its Constitution, Democracy, Religious Freedom, and desire to have our policy as a Nation to the best of it’s ability reflect the Golden rule of “Do unto other as you would have them do unto you.” (paraphrasing Matthew 7:12 and Luke 6:31).  Yes there is a vocal minority who oppose it and are secular and are now very excited to point out what on face appears to be the glaring hypocrisies of the professed Christians who support anything President Trump does, despite what effect it has on life outside the womb.  I’m sure you’ll argue that they were your audience.  However, you know better don’t you?  You know darn well your audience is the Conservative Religious who want you to feed their outrage and self-justification with demonizing paraphrasing of the intentions of people you clearly don’t really know nor care to get to know.

Pope Francis said these words in October 2016 “It’s hypocrisy to call yourself a Christian and chase away a refugee or someone seeking help, someone who is hungry or thirsty, toss out someone who is in need of my help.”  Matt, I don’t think either of us is a Theologian.  Can we agree that Pope Francis is?  A policy targeting refugees (and even immigrants here legally) specifically directed at whose who hold passports from 7  predominantly Muslim countries, one of which is in the middle of one of the greatest humanitarian crises due to war, seems like a pretty blatant case of singling out and tossing out those who need us most.  I know our Pope has not said anything specifically directed at recent events.  He doesn’t need to.  And you know what, I just realized, what the heck am I doing?  You have proclaimed yourself a professional truth sayer, as if you have the monopoly on truth and are the sole authority on Scripture, our Political system, the Constitution, and what protecting our nation entails.  Nothing I could ever write could possibly counter the professional truth sayer.  Like you say, it’s your profession.  There’s probably no point in pointing out to you the hypocrisy in your extremism, is there?

And with that, I’ll forgo editing this for time’s sake and get back to my real jobs.

An Open Letter to my “Pro-Life” Friends

To all of my fellow Catholics, Christians and Pro-Life Friends, and anyone who will read, Post March-for-Life day 2,

Admittedly, I used to consider myself Pro-life……and I still do, if I am correct on what that term means.  However after recent Executive Orders by President Trump and the consistent message I saw while following the “March for Life” that really it was solely about unborn babies lives, I just don’t feel comfortable calling myself Pro-Life.  Obviously I am making some generalizations and the media focused on abortion as the primary issue at the march (as it always does) and I realize that.  I’m hoping to clarify how I reached my current impression of the label “Pro-Life” and reach out to my pro-life friends as an olive branch to help me not feel this way.  Because I know all of my friends who attended the March for Life are loving, holy, beautiful people.  While our FB relationship is our main mode of contact these days, I have at some point lived near (or am related to) each of you and gratefully gotten to know you on a personal level and what Grace-filled people you are.  But here is what I don’t understand:

Is the term “Pro-Life” meant to only refer to those lives that are in the womb?  Because I am really confused.  I watched the coverage of the March for Life, and the only mention I saw of other life issues was was a brief clip of someone interviewing people, and a tiny minority of those mentioned the other issues (like helping the lives of the poor, the outcast, the immigrant, the refugees).  All of the signs were just about abortion.  That’s it. I understand the theology, philosophy, and teaching behind life starts at conception.  Since I’m also a physician trained broadly I also understand the physiology and science behind it.  I totally agree.  Human life starts with conception. And ALL human life is equal in dignity, and we should defend the dignity of natural life from womb to tomb until our dying breath.

So here is where I am confused.  If we agree on the above bits, which I think we really do, then why do I get the overwhelming impression that those who ascribe to the “Pro-Life” mantra and attended the March (or would have if they could) only did so for the dignity of lives within the womb?  I realize I am vague here.  Let me explain how I get that impression.  First of all, I recognize Facebook is not the perfect sample, but it happens to be one of my only avenues for connection to my friends and family far away and what they think, feel and prioritize (and to see their joyous moments and rejoice for them).  I’ve also not subscribed to other social media outlets because, well, they can be pretty addicting and I discovered facebook first (although I am rethinking this strategy).  And for a good 90% of my Facebook friends and family that attended this year’s March and have, I know, attended in years past, the sole political and/or life related thing that is ever ever posted on their wall is regarding abortion.  Likewise, the sole thing on my facebook feed that ever gets any likes from them are posts against abortion.  Otherwise it’s fun family and personal photos for both posts and likes.  I know facebook feeds us what we want to see based on our history.  I totally get that not everyone can advocate for everything and so prioritizing and focusing on a cause of utmost importance is necessary.    It’s similar to medicine.  The majority of American Doctors specialize and get a narrow focus because it is really hard to do a bit of everything and know one’s limitations.  We also don’t get paid well to be Generalists, so it’s less fiscally rewarding for more burden.  Within the wide umbrella of pro-life causes, it is good that we have some who make their specialty fighting against abortion and it’s also good that we have generalists for the pro-life cause.  I see some parallels though to those who have made eliminating abortion their pro-life cause at the exclusion of all else to a certain ilk of specialist I have come across in the medical field.  Being a family medicine doc first and then a geriatrician who is a generalist in all things aging, I have found two types of specialists.  The first type are for their patients first, and therefore appreciate and communicate with me for what I add to our mutual goal of caring for patients even if it means our patients don’t need their specialty services for a time.  Then there are the second type of specialists who find me threatening (fear me) because they know, particularly for the Geriatric population, if our mutual patients don’t need a procedure they offer that the patients will consolidate all their medical care with me (because it’s safer and more convenient).  And they will lose patient volume until a procedure is necessary, at which point I will instead refer to one of the first types of specialists who I know communicates with me.  Thus the second type of specialist also looses the lucrative procedure that I otherwise would have referred them.  The second specialist approach is actually self-defeating.  They are unwilling to concede that perhaps anyone other than themselves might benefit the whole of the patient.   They eventually lose business and word gets out that they don’t play well with others. Yes, I’m using the well-being of a patient as a representation of the Pro-life movement as a whole.  To date, I have never seen any of that 90% I referred to ever even acknowledge that there are other issues that greatly threaten the dignity of human life.  I’m not asking to make those issues your specialty within your advocacy for life, but some appreciation of those other issues is indeed helpful and crucial to the whole of the “pro-life” cause.  And without communicating it, I can’t tell at all that you have that appreciation.  Which baffles me, because I know you love and know the gospels and also recognize that there is far more to the defense of the dignity of life than the defense of the unborn.

I saw many posts from Facebook friends from the March for Life and consistently only the unborn were mentioned.  Check that, I saw a friend note first their enthusiasm for ending abortion, and then tagged on that they were in defense of the dignity of natural life from womb to tomb.  I find the “tomb” bit vague.  The “Right to Life” coalition where I currently reside has diabolically miscommunicated to the masses that they feel defending life at the tomb end means using artificial and invasive means to maintain people having a heartbeat for as long as feasible.  Instead of celebrating and dignifying natural life, it has lead to horrifically undignified, artificial and unnatural means of intervening with what is clearly God’s will to bring His creation home to Him.  That’s possibly a pet peeve of mine due to my profession in Geriatrics and witnessing first hand the ramifications of certain types of propaganda at the end of life.  Still, there’s this thing I can’t figure.  If we are Pro All Life, womb to tomb, regardless of ethnicity, culture, religion or creed, then why are none of the Pro-Lifers as the March for Life (that I know, and I know quite a few) speaking up for other life issues, at all.  I mean, again, I get that your specialty and priority within pro-life is ending abortion.  But does that also mean you can’t say anything against the recent Executive Orders that have literally denied refugees, the poor, immigrants just looking for somewhere to have the freedom of dignity of life?  Can you not acknowledge other life issues?  Will you counter President Trump with his other anti-life policies, like restricting refugees (Matthew 25: 35-40) from specific countries that he deems a threat (but interestingly not the countries where the most terrorist have originated that he also has business dealings with)?  Or like suggesting he’d keep a running tally of all the crimes committed by immigrants or Muslims (this is exactly what Hitler did to the Jews to kick off the Holocaust)?  Will you speak out against gutting the Affordable Care Act before an iota of an idea for a replacement plan exists, thus ripping basic LIFE-saving healthcare from millions of Americans?  Will you not speak out against the type of “locker-room-talk” and objectifying language that President Trump has routinely uses that certainly does not bring women (the well being of which predicates a successful pregnancy and birth as women are the vessel of the unborn life) up?  I have been paying attention, and while perhaps you also feel at your heart these other issues are important and maybe even prayed on it, the very clear image you have presented to the world is one that makes pro-life solely about abortion without any communication to suggest you acknowledge the other issues.  And I, frankly, really just want to know if you do?  If it was part of the March for Life, if you discussed things that were important to the dignity of every human life other than only abortion, could you please just say so, make one comment about some other than abortion life related issue in your postings and advertisements about your participation in the March, or even like this when I post it on Facebook?

Pope Francis’ gracious message to President Trump concluded in this way, “Under your leadership, may America’s stature continue to be measured above all by its concern for the poor, the outcast and those in need who, like Lazarus, stand before our door.”  The reference to Lazarus in the Gospel of Luke, I believe, is crucial here.  Luke 16: 19-31 is the parable of the rich man and Lazarus.  All we know about the rich man from the Gospel is that he was rich, dressed fancy and ate quite well……….and also he is the only person in all of the parables of the Gospels who definitively landed himself in hell.  What landed him there?  Nothing other than being rich and not opening his door to Lazarus, the poor man.  I don’t know why, but I do know that the only person the Gospels suggest is undoubtedly permanently separated from God was a man whose only sin was to be rich and get too comfortable (not a murderer, a sexual deviant, or a democrat), and in doing so ignore Lazarus.  I’m not a huge fan of fear tactics as fear of fellow brothers and sisters in Christ (all of humanity) only breads anger and hate.  But fear of God is worthy fear.  So I ask those who marched for life, can you not see the parallels between Lazarus and the poor immigrants and refugees of the world knocking at our door?   Do you acknowledge that there are many other issues just as important as ending abortion to the Pro-Life cause?  If so, please say so.  It doesn’t need to be your main thing, but by ignoring the other issues or refusing to acknowledge them due to your devotion to abortion, it seems as though you are acting like the second type of specialists I referenced.  That type of medicine is detrimental to the well-being of patients.  My fear is that the type of Pro-Life activism which emphasizes ending abortion through legislation and Executive Orders at the exclusion of all other life issues is similarly self-defeating and detrimental to the Pro-Life cause as a whole.  Enlighten me, clarify this for me, and really just acknowledge that there is more to being Pro-Life than the issue of abortion.  And if not, just tell me so I can separate myself from the Pro-only unborn life movement and work to create a Pro-All Life movement based in the truth and love of the Gospels.

 

An Open Letter to my “Pro-Choice” Friends

To my pro-choice friends, and anyone willing to read, Post-March day 3,

I am one of the women who considers herself a feminist, maybe not in the typical sense, but a feminist nonetheless who was made to feel like I didn’t have a place at the Women’s march.  Admittedly, I am super sensitive to exclusive behavior.  I don’t know if it’s because I was bullied as a kid or what, but nothing irks me more than when a group that I feel connected with (like the group that purports to speak on behalf of my ENTIRE gender) excludes me or anyone really.  Maybe that’s why I’m an Independent and don’t subscribe to labels such as liberal or conservative or parties such as Democrat or Republican (it’s super inconvenient and lonely in our bipartisan system).  I confess, I didn’t actually go to the DC March or the one in my hometown (more due to logistics of my son’s over-packed Saturday schedule than hurt feelings).  But had I felt welcome, I would have prioritized the march over consecutive 7 year old birthday parties on Sat Jan 21, 2017 because I am an ardent supporter of human-rights, better treatment of all women everywhere, immigration, equality for the LGBT community under the law, separation of church and state, basic healthcare (including contraception) for everyone who needs it, Black Lives Matter, opposing dictatorial leaders such as Trump from gaining unbridled power and really all social justice issues.  The Women’s March official website, under their “Unity Principles” tab, states, “We do not accept any federal, state or local rollbacks, cuts or restrictions on our ability to access quality reproductive healthcare services, birth control, HIV/AIDS care and prevention, or medically accurate sexuality education. This means open access to safe, legal, affordable abortion and birth control for all people, regardless of income, location or education.”  Frankly though, I am big enough to let that slide because with the exception of the abortion bit, I am on board with all of it, including access to reproductive healthcare services and prevention such as birth control.  I’m a devout Catholic family physician who has never used contraception personally.  But that’s a personal choice enlightened by my faith and allowable due to my privilege of being white and having an extremely supportive and intact family and high education status (I’m a medical doctor).  What really tipped me over into feeling unwelcome was when a Pro-Life secular group called New Wave Feminists were taken down from the Partner’s page of the website with this message from the organizers: “The Women’s March’s platform is pro-choice and that has been our stance from day one. We want to assure all of our partners, as well as participants, that we are pro-choice as clearly stated in our Unity Principles. We look forward to marching on behalf of individuals who share the view that women deserve the right to make their own reproductive decisions. The anti-choice organization in question is not a partner of the Women’s March on Washington. We apologize for this error.

Here’s the thing.  I have so many amazing friends who are inclusive, amazing people, pro-choice and despite knowing my views on abortion would have made me feel so darn welcome because they know damn well what I stand for and that it’s for them and all women and humanity and essentially relieving suffering wherever I can in my imperfect but genuine way.  On the other side, I am an avid reader who believes in going to primary sources, thinking critically and accepting facts that are indeed facts (and not alternative facts).  The facts are this.  The primary page for the Women’s March and organizers made it VERY clear in the above statement to all of their partners and participants that they are only “marching on behalf of individuals who share the view that women deserve the right to make their own reproductive decisions  [which they clearly define abortion as a reproductive decision]”   There is another kicker in all of this, one that actually hurt me more than the exclusionary statements from the official organizers.  On the Mission Statement page, they say “In the spirit of democracy and honoring the champions of human rights, dignity, and justice who have come before us, we join in diversity to show our presence in numbers too great to ignore.”  It’s beautiful and I thought it was speaking to me.  They also have a quote from Audre Lorde stating “It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.”  Silly me. I thought after reading those beautiful quotes that the March was about all women everywhere who work to bring women up, not just the ones who believe that access to abortion an essential part of that.  And yes, it was far more than the organizers that finally led to this “open letter”.  After the march, I saw some very encouraging Facebook posts from the day that were focused on all the other issues other than abortion that people were about at the March, and I was happy and grateful.  Sadly, it took a turn for the worse.  I saw the few like-minded to me people hint at their frustration with feeling excluded and the barrage of exclusionary comments that essentially reduce all things women down to being for or against access to abortion.  Women stating, “If you aren’t for women having the right to chose what to do with their bodies, then you shouldn’t be at a women’s rights march.”  There was the friend who asked if I was going to the March, and when I confided that I didn’t feel totally comfortable because it seemed more about being pro-access to abortion than all the other social justice issues I fight for, her response was, “If you don’t like abortion, don’t have one.”  I could go on, there were many many more posts and comments clearly making it about abortion.

While I am so grateful to my friends and those who were inclusionary, the overall message from the group’s organizers and the many comments suggesting that if I wasn’t gung-ho for more access to abortion that I really didn’t have a place hurt.  It lacked love, compassion and an open-mindedness to a diversity of thought.  I saw an awesome interview from VP Joe Biden in which he noted a lesson he learned that to not attack motives, but to attack judgement.  Well, I feel like my motives have been attacked.  I’ve been straight up told that if I’m not pro-access to abortion that I am somehow not for women’s rights and even better choices for women.  And it’s just not true.  Moreover, it was even more heart-wrenching because I have already received enough flack from my faith community for voting for Hilary (due to her pro-access to abortion stance).  My old Parish Priest and I thought personal friend replied to an article I posted on Facebook entitled “Thanks to Trump, We Can Better Understand How Hitler was Possible” stating, “…..We are called to be a  faithful Catholic citizen and vote with our church, not against her.”  My response was this, “First and foremost our Church urges me to form my conscience and vote based on what I know is right. There is a separation of Church and Sate in this country (or at least there was) that is in our constitution and equally important as the 2nd Amendment. I didn’t know the Church took sides in American Politics………if it did where is Pope Francis’ comment?”  Needless to say we are suddenly no longer facebook friends (not my doing) and I am lonely and tired of being made to feel like I don’t have a place within my Church, a political party, a social group, my entire Gender’s cause, my profession, etc because my views don’t consistently align with “liberal” or “conservative” labeling and exclusionary rhetoric.

So, now that I’ve expressed why I’m hurt, here’s who I am and what I’m about.  I’ll let you decide if you think I should be made to feel welcome at a Women’s Rights March.  I’m first and foremost a woman.  I am Pro All-Life.  I am imperfect.  I am Catholic because I believe the teachings of my Church to be the best way for me to find God and be the best I can be. I also realize my Catholic faith is made up of many imperfect humans just like me and it takes a lot out of me to not let the hurt that people have caused in the name of the Catholic Church to shadow the actual message of my Faith.  I recognize my privilege in being lucky enough to be born to an amazing supportive white family with a strong emphasis on education and knowing my own self worth.  I also am a Family physician/Geriatrician, and I became a mother at the most inconvenient time relative to my profession in 4th year of medical school while married to another 4th year medical student.   Despite having an awesome family, they didn’t always have money and I had to rely on medicaid to have access to essential prenatal, maternity and childcare.  I can’t imagine what I would have done had I not qualified for medicaid but also couldn’t afford healthcare.  Personally and professionally I know how crucial access to basic healthcare and education are for true freedom and opportunity.  In practicing family medicine, I have listened, felt the pain of, suffered with and felt the injustices of our society of hundreds of women of all socioeconomic backgrounds, races, religions, ages and creeds.  I have felt powerless when I hear my female patients or even friends tell me stories of how they define their worth based on what a man thinks, or they were made to feel objectified or less than, or when they told me they had an abortion because they couldn’t support a child on their own.  It breaks my heart because after what I have done, worked for and been through, I know that in our society women can’t have it all, but we certainly can do it all, and we do so while creating life with our own bodies.  I also know that this is a very threatening prospect to men with big egos and many insecurities.  As a mother, I know the miracle that I created.  I also have been infertile since my one and only and know the pain that comes with not being able to create life as I once did and the frustration with how difficult and costly adoption is.  As a physician, I know the difference between disease processes, natural physiology, and when the two play a dangerous dance.  I know well what it’s like to be stereotyped based on my looks, gender, or religion or to have very un-me things assumed falsely about me.  As a scholar, I know that semantics and definitions matter and should only be narrow if highly specific.  I know that the term “pro-choice” tries to paint a broad stroke where it shouldn’t.  Technically, reproductive health care is a misnomer if it includes abortion.  If one is already pregnant, then they have technically already reproduced, and abortion should not be clumped in with reproductive health care as abortion has nothing to do with reproduction (as it already took place).  It’s reasonable semantically to include both contraception and fertility treatments in the term reproductive health care, and also preventative care.  Also, when a “choice” is made out of fear, or desperation, or any negative unloving constructs that our society has forced upon women than it is not really a choice at all.  Lastly I am a Geriatrician.  I am the most needed and yet most taken for granted type of doctor there is in America.  Despite this, I never stop fighting for my patients, loving them, caring for them, taking the time despite not getting paid for it to do the right thing.  I’m not only a Geriatrician because the type of medicine suits me.  It’s also because I know that every patient that I help through old age is a patient that likely died or will die with dignity towards the inevitable end of their natural life (while simultaneously not costing our tax payers millions that could be otherwise spent on younger future generations in non-curative and futile medical treatments).   I do not fit into a stereotype.  But I thought I fit into the category of a woman fighting for Women’s Rights in the best way I can with the tools and gifts I was born with……until the organizers of the Women’s March told me I didn’t and many women reinforced that.

So, now that you know me, what do you think?  Did I belong at the March for Women, possibly the only gathering of its size ever without any violent incidents (probably because it was organized for and by women)?  If you think its purpose was inclusive of women like me, then please let the organizers know.  I appreciate the apologies for having my feelings hurt by being excluded, but that’s not enough.  If we (women) really want to bring all women up, we need to be open to anyone willing to fight that cause in whatever form and we must make it clear we’re open.  We can’t state our mission as inclusion and diversity but then explicitly exclude anyone who has a diverse thought other than our own as to the means to achieving the shared mission of the cause.  It’s by making women with loving motives and good intentions feel like we aren’t pro-woman that we fragment ourselves.  Every pro-life, anti-abortion woman I have ever met not only takes the stance at the defense of the unborn life (or other body we don’t seem to want to acknowledge) but also because she truly and at her loving core believes that abortion is not good for women and overall hurts women everywhere.  And we have to be honest with ourselves.  It’s an amazing and powerful thing to be able to grow a human life inside you.  When society is constructed in a way that makes women believe their greatest physiologic power (and essential for the future of our human race) is an inconvenience, then it’s a tragedy committed towards women and our future children and the society that must change.  There are many women fighting for those necessary changes while still being pro-life.   When we fragment ourselves, we hurt our unity and we hurt ourselves, and then people like Donald Trump get elected.  Not every pro-life woman with good intentions is as experienced with diversity, as objective in their news and fact sources, and as knowledgeable about our Constitution and politics as I am.  If we are honest with ourselves, this election result was as much about the disenfranchised white rural person as it was about the pro-life religious right feeling the wrath of liberal intolerance and having no other way of getting their voice heard than to vote for an objectively anti most life other than rich white men and persons who can give him power based on the single issue of abortion.  I had this inkling on November 10th, along with an awful sinking in my stomach of the horrific reality of what was to (and now has) come.  I had so desperately hoped the Women’s March would help heal and prove me wrong.  Instead, the Organizer’s went out of their way to exclude pro-life women, and thus proved me right.  I won’t pretend, I like being right, but not always.  It was not even bittersweet.  It just made the hurt more, like my faith in women and people was crushed even further than it already was this year.  It was just a bitter and awful kind of right.

My hope now is that my pro-choice friends, all of them, will be open-minded enough to read this open letter.  After that, I hope and pray that we, women and men for women, will not make this mistake again.  If we are about all women and diversity and inclusion, don’t allow those who speak on behalf and for the entire cause to alienate a not insignificant number of women who are fighting for women’s rights too.  There’s a multitude of issues, for better or worse, that all contribute to equality, dignity, justice, and women’s rights.  Do you really need to constantly talk about your stance on more access to abortion as a means to find common ground with me?  Cuz right now that’s what it feels and sounds like……and it certainly is not building any bridges where we can meet in the middle.

Inspiration for this post came from www.Icantkeepquiet.org/thesong/ and I hope they’ll have me despite my pro-life stance.  Also, if you prefer more scholarly and eloquent writing, here’s another “open letter” https://www.firstthings.com/web-exclusives/2017/01/an-open-letter-to-my-liberal-friends.

 

 

 

 

 

A Moderate’s Plea

I had hoped that our nation’s absurd 2016 election result in electing a tweeting, whining, entitled, inarticulate, narcissistic (yes I am a doctor who had dealt with a lot of mental health issues, it’s an appropriate adjective in this case), reality TV show host would pull our polarized egos out of our extremist behinds and bring people together a bit for the common good.  I was wrong.  So this highly educated physician mother is going to beg that we start using reason, compassion and logic in going forward instead of whatever the heck it is we’ve been doing and are doing.

Dear Democrats:  Why are you becoming more extreme?  Answer me honestly; do you really think abortion should be a thing that any woman should be able to get whenever she feels like it?  Or, do you feel it’s a necessary evil due to societal ills?  I hope that your answer is the latter; in which case I think I can help you achieve your goals more efficiently.  Your goal, if I understand you correctly, is absolutely not that women have abortions.  Rather, you would like women to have unfettered and fair access to healthcare, contraception, and prevention without antiquated judgments about how we choose to use our amazing bodies.  Furthermore, you have seen how poorly our society treats and supports unwed women and single women with pregnancy or children and how corporate America and the higher education system treat pregnant woman or mothers like victims of the plague.  So, you feel for women and it’s too big a fight to change society so rather you would just advocate that these women have easy access to abortion.  Does that sound right?  Well, just say that instead of applauding the sadness and tragedy that is aborting a human life. You would have so much more credibility and progress in actually changing society, changing hearts, and gaining necessary access for women if you stopped advocating so intensely for abortion.  Drop it from the vernacular and focus on access to education for women and contraception.  Advocate for better care for all women, those who are mothers and those who are not. Continue to speak out against misogyny, locker room talk aka rape-talk, and the objectification of women.  Stop clumping abortion into the “pro-choice” category.  Having an abortion is not a choice.  Nothing done out of desperation can actually be a free choice.  No woman who valued herself and her awesome life giving power would choose to end the life inside of her unless circumstances were dire, whether due to mental debility, economic hardship, or even complete lack of support and hope for upward opportunity for herself and her unborn child.  Women should 100% have choice and agency over their bodies, including if they’d like to be sexually active without conceiving. However, once another life is in the mix, it’s not just the woman’s body. Let’s fight so women don’t have to be ashamed of the awesome power they have to grow a life inside them.

Dear Republicans: You need to gain back some credibility. Stop believing everything on FOX news. Stop propagating lies and fear. You have access these days to all the information in the world, so use it before spreading untruths. Many of you just elected the most unsuited and unqualified candidate to our highest office because of one-issue voting (like being against abortion) or because your insurance premiums on the ACA (Obamacare) went up. With the exception of Russia and a select few white-nationalists in other countries, our world-wide credibility as a Nation that supports freedom, equality and justice for all has been irrevocably damaged if not lost all together. Stop denying climate change because when you do so you inadvertently seem to not care about the lives that are ravished by it’s effects, usually those in the poorest areas. Most importantly, please recognize that right now the sole reason Planned Parenthood has to exist is not for abortions but because it is the only place women without health insurance or Medicaid can get access to contraception, preventative care (pap smears), STD treatment and education as to how to prevent STD’s and pregnancy. Planned Parenthood is currently a necessary evil exactly because our country does not have a single-payer option as a backup for everyone to ensure basic preventative care and basic healthcare needs. Admittedly, I will not ever support PP due to the abortion issue, however I can recognize why it has to be here. Try being open to a publicly provided option for healthcare for everyone and maybe you’ll find that indeed, once all women have access to all the other care they need through public clinics and centers, the real reason for planned parenthood will only be abortion. Then there would be no argument to fund it other than abortion.

Moreover, stop ignoring the fact that to support life in the womb we must support the vessel of that life (women, I’m talking about women). You can’t dismiss derogatory talk, locker-room talk, sexual assault talk that is specifically meant to put women in “their place” and be pro-life at the same time. It’s that dismissive attitude that leads to further objectification of women, policies that make it impossible for women to both support their families in the working world and cope with an unexpected pregnancy, and insidiously persistent yet oppressive views towards women. It’s super easy to be an advocate for the innocent (the unborn child). It’s not as easy, but so much more necessary, to do as Jesus did and bring people out of their sin while at the same time loving and helping them (the time Jesus prevented the hypocritical Pharisees from stoning a whore by standing in their way and saying “Let him who is without sin among you be the first to throw a stone at her.” is coming to mind). Start advocating for women in general, even the ones who have made lots of mistakes, rather than abandoning them when they need it most.

Finally, Dear fellow moderates: Please speak up. I am lonely, so lonely. I think the USA has proven that the emotional partyism path pushing everyone to extremes is not healthy, not loving, not truly democratic, not unifying and not working. I know there are more people out there like me. People who have consistently had to choose a candidate to vote for that they didn’t always agree with on everything but recognized that in our bipartisan system one’s vote only really matters if it’s for a democrat or republican (and sometimes doesn’t matter either way depending on your state and electoral college).  I know more have taken this road less traveled. We have been silent too long, so please speak up. I’ll leave you with these quotes. “We must learn to regard people less in light of what they do or omit to do, and more in light of what they suffer.” – Dietrich Bonhoeffer.  Finally, “May we think of freedom not as the right to do what we please, but the opportunity to do what is right.” – Peter Marshall.

The Best of Both Worlds – A Capitalistic Case for a Public Single Payer Option and Private Sector for Health Care in America.

I think I’ve bitten off more than I really can chew with my first idea for a post, but I am going to go for it anyway.  As a family doc geriatrician, I have treated people from literally every arena (medicaid, medicare, private insurance in all it’s variety, and uninsured).  I know first hand the risk of a federally provided program that is over-regulated and that does not actually put money into quality relative to the population’s needs (yes I am talking about Medicare).  I also completely recognize that whether it be a “right” or not, healthcare is a business.  Money is involved, whether at the government level or the private insurer level.  Yet if we truly are a country that believes first and foremost in everyone’s inalienable rights of life, liberty, and the pursuit of happiness, than how can we as a nation not provide some minimum standard of healthcare for all it’s citizens?  What one thing does everyone need to live, to have liberty and be truly free to pursue happiness?  Their HEALTH (mental and/or physical)!  I am not advocating for a single payer system publicly funded that pays for EVERYTHING.  However there are a number of basic things that are non-controversial that can easily be agreed upon that yes, our government and our taxes should pay for so that everyone in our society can have their best chance at success.  If you want to bring free-market economics into it, then allow for the private sector.  But when people are desperate and feel their lives depend on something (whether they really do or not) they will pay anything, say yes to anything, and ultimately competition and free-market choice just don’t apply.  The American Healthcare system already rations care.  Insurance, private docs, medicaid and medicare all have rules as to what they deem valuable and will or will not do or pay for.  I’d contend however that despite our highly polarized country, there are very basic healthcare and medical needs that Democrat and Republican alike could agree on to be covered for everyone in a nationally funded and provided healthcare system.  Some of these include basic preventative measures like vaccines, pap smears, contraception for women (note I differentiate contraception from abortion……they are different, very very different), basic health literacy education, screenings for treatable chronic conditions and treatable cancers, etc.  Then there are common ailments that are easily treatable (at a certain age) no one expects to get but also should not financially ravage a person or a family if they do, such as an appendicitis, a pneumonia, a traumatic incident or a heart attack.  If the primary panel that determined the type of care needed was made mostly of PCP’s and General surgeons, I’d wager a million to one they’d come up with a bipartisan agreement on what should be covered.  And no, not everything would be covered under a national healthcare system.  Just like in the public school system, not everyone gets a voucher to go to whatever expensive private school they like.

Ok so say we do this (I am an idealist and a cynic at the same time…..I know we aren’t going to do this)?  Who would work in that system?  Most American Doctors are extremely FED UP with the regulations, oppressive burdens of medical school debt, bad technology at our disposal, administrative burdens, I could go on forever, that distract from our ability to care and form relationships with our patients.  For this kind of thing to work, we’d have to step outside of our bubble and not be constrained by the many issues of our current private and public Health sectors.  We’d need to take the good things from other countries of comparable standing and be willing to use what could work for us.  Meanwhile we could tap into the amazing resources and technologies we do have in brain power in our own country.  So what could this look like?  Let me tell you.

  1. Scrap Medicare and Medicaid, completely, and start over with a United States National Health System (USNHS).  This would be similar to Medicaid in that it would be a Federal and State program.  Certain minimums would be mandated by the Federal government that would be agreed are basics that must be provided and the current Federal social security tax/medicare federal would essentially become the USNHS tax.  This won’t be enough though for coverage of everyone and therefore allow the States to both administer the plan and levy taxes in whatever ways they feel will work best relative to their respective State needs.  We have 50 vastly different states in this country.  To assume that the needs of one are the same as all is just naive.  Therefore in setting this up, allow for some State autonomy.
  2. Will this be something we can afford to fund with taxes? – Heck yes.  Again it should NOT pay for EVERYTHING.  The USNHS should cover acute, chronic, and preventable healthcare needs agreed upon by experts in medicine and public health (I’d contend mostly family physicians from both urban and rural settings) based on age and likelihood of successful prognosis with treatments.  Yes there will be rationing, as there already IS in every single aspect of healthcare.  However when people find their income is much greater because they did not have to elect for the employer covered private insurance benefits that make healthy people pay for very sick people who over-use the system they’ll find that despite a slight increase in taxes, they’re coming out ahead.    The payment for the physicians and other medical providers should be time-based relative to their expertise and degree level, rather than volume and procedural based.  If payments are time based (like an hourly salary) then physicians are more likely to take the time to explain things, to get a proper history so we don’t just order costly tests, to take the time to talk to other health team members, and to re-establish the sacred relationship between a doctor and patient.  If time-based then we don’t need the Electric Health Records that were built based on cumbersome and business minded ICD-9 or 10 codes.  The USNHS could establish a nationwide EMR created with 80% input from medical providers and 20% from computer coders and engineers that would allow easy documentation the way providers need and want it.  Also, because it would be national, if a patient stays within the NHS, it would be visible from any USNHS site.  So if they seek care, there would not be more ordering of unnecessary, costly and sometimes risky tests because providers in the USNHS would be able to see results and notes from other providers, even in other states.
  3. Who would work in this system and will a time-based salary make people lazy? – If set up correctly, it would be very attractive and no, it won’t make medical providers lazy.  First of all, I am not advocating (because it’s far too much of a long shot) for almost free medical school education (like many of the countries with socialized healthcare have).  However, we could very easily incentivize people to work for the USNHS if we offered complete loan repayment for those who dedicated at least 4 years (or maybe however many years their residency/fellowship training was) to the USNHS.  Just for reference, I took out over $150,000 of loans at 7% interest that started accruing immediately after med school and annualized quarterly.  I also had a few loans at higher interest rates.  I did 4 years of training (3 years residency, 1 year of fellowship all working about 80 hours a week getting paid 50,000$ per year).  Now, as a full fledged expert Geriatrician with a job at 80% time (part-time is actually not a thing as a primary care doc) I get paid 120,000$.  Before you tell me to stop whining, do the math of my loan payments and hourly wage based on time worked (and inquire into what other professionals of comparable IQ and education level get paid relative to debt burden).  If I were not married to an Anesthesiologist, I would not get out of debt and be able to cover basic costs for living and my one child for near 30 years.  If it were a true national program, then there wouldn’t be horrible constrictions on where people would be placed, because likely there would be an opening near where they want to be (currently you can get your student loans paid for if you commit to being placed in literally wherever, often Native American Indian Reservations, Alaska, or the most challenging Federally Qualified Clinics, for at least 4 years after residency).  Also, if the USNHS is set up correctly, many quality family doctors and altruistic health providers would be attracted to the concept of getting the time necessary to establish relationships, educate people about their health and healthy living, and less administrative burdens that I would bet a number of people would stay on with the USNHS despite the overall lower salary paid than the private sector.  There would certainly be more Geriatricians.  And the argument that salaries make people lazy……sorry but no.  No medical providers make it through our training system (whether it be nursing, physician, Nurse prac, PA, etc) by being lazy.  If they get burned out by our current awful system and start doing less, yeah it’s the system.  Medical providers are not inherently lazy people and salary paying the altruistic ones who work for the USNHS will likely only improve care.
  4. What about Capitalism and the Free Market and Competition and the Private Sector – Good news!  We’re America.  People are easily swayed that they need fancier things, treatments to make them live longer, look younger, look skinnier, or even that just because it’s more expensive it’s somehow better.  And the people want choices!  Why do you think Dr. Oz is so successful?  There will always be a free market for healthcare if the basic needs are already met (like with a USNHS).  Why do you think plastic surgeons who do boob jobs (clearly not a basic necessity) always make bank and have a steady supply of patients?  That’s maybe an extreme example.  Here are some more.  There will always be cosmetic Dermatologists that people will pay for if they have the means.  There will always be fertility specialists offering IVF if you can pay for it.  There will always be someone willing to do your surgery for the right price even if you are risky and it’s not an emergent medical need.  And there will always be doctors willing to keep you alive on machines, or perform a code on your 85 year old Grandma, or offer you chemo they know will not help because you have a strong Faith in God and miracles.  And they will charge you what the market will bear.  And yeah, they’ll have to be better because they will be competing with the USNHS, which will only control costs, improve care, and make for happier Americans all around.
  5. How would this approach support Capitalism, Free market exchange of goods and ideas, entrepreneurship, etc etc etc? – I’m frankly dumbfounded that this isn’t more obvious to politicians and economists.  But then I recall that many politicians and rich business people respond more to the needs big business and big money than the average American working class, rural or urban.  They also are not physicians……or at least the physicians that are on the front-lines of healthcare.  How many of you reading this (I’m hoping I’m getting other views than just medical professionals) have wanted to start your own business, or have an awesome idea that you really think could work, but also have a family to provide for?  How many of you work for an employer who you don’t love, isn’t particularly fair, does not necessarily inspire you, but does provide for basic healthcare benefits so you and your children can get vaccines and basic care if someone breaks a bone or gets an appendicitis?  How many of you know that if you started your own small business it would be successful enough for just the right amount of profit that you wouldn’t qualify for medicaid?  I bet there are a number of you thinking, “yeah, heck yeah, that’s me.”  But, you stay in your corporate big business job and never bring your awesome ideas to our “free market” because your health and your family comes first and you can not take the risk that their healthcare needs and your benefits wouldn’t be met.  So how is this system of no true basic minimum of healthcare met publicly helping capitalism and the “free market”?  It’s not.  It’s helping the already rich corporations solidify their monopoly on ideas and the market.  It’s helping the already billionaires eliminate competition because we are not allowing our true potential to be met.  By trying to force a basic human need, such as minimum healthcare standards, into a private free market capitalistic system, we are actually harming capitalism, the free market, and fostering monopolies.  Did this system make sense at one point?  Yes, it did.  But that was years ago.  Our medical knowledge, treatments, and possibilities and treatable issues have changed drastically.  So it’s time we get up to speed with the times and change to.
  6. How could this be bipartisan? – First of all take a deep breath and try to use reason, logic, and empathy.  Remember the First Amendment that separates church from state.  For a USNHS to be publicly funded, we would need to come up with a compromise of funding non-controversial things.  I will say, abortion and physician assisted suicide should NEVER be publicly funded with our tax dollars.  They are issues that are controversial, rooted in human life and dignity, and never anyone’s real choice as when women or persons find themselves in those situations it’s because they are desperate.  However, contraception is a thing that should be funded publicly with our taxes, as it gives women autonomy and agency over their bodies.  This is coming from a devout Catholic who has never used contraception.  It should also cover free sex education for everyone starting in 8th or 9th grade as part of the federal mandate, including what it’s for, the risks, respecting others and how to choose responsibly to engage in it.   It’s reasonable to cover it publicly, and if we did, and provided a USNHS that actually gave free preventative healthcare and education to women (but not abortion), we’d essentially eliminate the arguments for funding Planned Parenthood as the only thing they’d provide that women couldn’t get at their USNHS clinic would be abortion.  Think about it!  Likewise, hospice and palliative care for terminal conditions should ALWAYS be covered.  If you are someone that insists the medical field do absolutely everything invasive for yourself or loved one despite a dire prognosis or clearly terminal condition because you think it’s God’s will for a miracle……GREAT!  But don’t expect the state USNHS to fund that with American tax dollars.  Miracles are for God, the Churches and religion, not the publicly funded health system.  Pay yourself or get your church to fund-raise.  It’s your choice, it’s a free country.  I could go on and on about medically rational and reasonable things based on science, evidence, epidemiology and experience to cover publicly and not, but this is already way too long.  The point is, don’t let emotion and blind following cloud your potentially well-educated and informed opinion of this issue.

In conclusion (few she’s almost done……bravo to you if you’re still reading this), don’t let the media, people who know nothing of health and medicine, or those who are medical providers but are also practicing in fields of narrow scopes while making out like bandits cloud your judgement.  We are in dire straights right now in this country and it isn’t sustainable.  We need a real solution and our health is not something that fits into supply and demand economics and free market capitalism.  It just doesn’t work that way.  There is a better way, a compromise of both (Obamacare was doomed from the get-go because to get support from Republicans it had to enmesh the big business health insurance industry as its means to expand coverage……it didn’t work).  I know this probably won’t be read (it’s far too long), that this kind of thing is not in our horizon.  I have good reason to be cynical.  But I can dream.  I refuse, as a woman, mother, Family Physician/Geriatrician, healer, wife, sister, daughter, educator, athlete, granddaughter, Christian, to accept that the status quo is our future.  And I’ve had a long day and my eyes can’t take anymore screen to go back and edit this for grammar and whatnot……Here goes nothin.