Are all med schools this liberal?

[osli]

There are generally four cases in which a minor has a right to speak to a physician privately about health issues (e.g., issues like birth control or abuse), but the exact age I believe might vary some from state to state. In all other instances, a parent not only has the right to be present but is typically responsible for making health related decisions for the minor.

---

Members don't see this ad.

 

[GoBuckeyes913]

The goal here is not to undermine the parents values and encourage the teen to sleep around. The fact is that while some teens are not sexually active, many are, either with or without the parent's knowledge. Sexual health and history is a very important part of your exam, and for you to help the teen achieve his/her optimal health, you need accurate and honest information about their sexual history. This is something they may feel the need to lie about in front of their parents. This is the ONLY reason you are asking the parents to leave. To facilitate honest communication. If you feel that it is important that the teen discuss this issue with the parents, you are free to encourage the teen to do so, but remember, he/she is your patient, and confidentiality applies. As far as contraception is concerned, laws on the matter probably vary from state to state, but either way your obligation is to advocate for the patient's health, and if that means providing a discreet contraceptive script, then that is your duty. It doesn't mean you urge the kid to go out and screw, in fact you can and should counsel them on the dangers they may be getting into. But you have to accept the position that the patient is in, and do what you can to help keep him/her safe and in good health.



Sadly, many women ARE in abusive relationships. This can be uncomfortable to acknowledge and certainly is a tough thing to discuss. But the fact is, many women are abused and many women will not necessarily volunteer this information. Again, remember that it is your job to advocate for and fight for her safety and health. This means that if you have any suspicion AT ALL that somethign like this may be going on, it's your responsibility to delve into it. This doesn't mean you're 'accusing' someone. It just means you're checking off all the possibilities. While it may be uncomfortable, the first time you find out that someone IS being beaten and can help that woman, you'll understand why it's worth it.



A complete medical history DOES include a sexual history. Do you think that just because that 75 year old hasn't had sex in the last week, that means that nothing in her sexual history could possibly have an impact on her current health? More importantly, do you really think that a 75 year old widow can't possibly be currently having sex? Plenty do.. And good for them! Being a widow doesn't mean SHE'S dead, after all, who's to say she hasn't met someone new! Also, there are plenty of people who are homosexual. This has implications on possible disease. There are plenty of bisexuals. ditto. Lots of people have been raped, both by the opposite sex and the same sex. This is important to know. These things are important to know so that you can insure that their sex lives are healthy and fulfilling. they're important to know so you can be aware of the potential for stds and other sexually related disorders. They're even important to know because sexual dysfunction can be a sign of other, non sexually related, disorders such as heart disease.


In the future, when you're being told things that you feel are meant to brainwash you into being a pinko, why don't you ask the lecturer for clarification, either in class or privately. I think you'll find that there really are good reasons for most of what they are telling you.

Nicely put

I'm not sure how for real this post is, but the OP does bring up so interesting points.
There are just some overall things in medicine, that we are obligated by law to do, that ethically and morally I have a problem with. As a future father, I would really like know if my little girl is having sex or is pregnant. The first problem is that she isn't close enough to talk to you as a parent anymore; the second problem is that we as doctors are forced by law to perpetuate this secret. But, like a good law abiding future doctor, I'll obey, but there are many aspects in practice of medicine like this that really bothers me. I'm not sure if I can call this conservative or liberal, but it just bothers me.

I don't think any father wants to know if his daughter is sexuall active, it's completely understandable how uncomfortable that makes you (or any other parent-docs) feel. Perhaps when questioning adolescents about sexual activity now you can develop ways to encourage your future children to be open with you. Also, while your patients may not want to open up to their parents, you can still have a great impact on them with education and guidance (I guess pseudo-parent-like?).....it may give them reassurance in confiding in adults, and eventually their own parents

As I expected, no one understood my complaints about the three points from our soft-skills seminar I mentioned, but many people responded. I can't reply to everyone, so I'll just take MattD's post as representative and reply to that.
My specific objection to this is the rule that the parents cannot be told if the adolescent doesn't want them to. You can say that's not liberalism, it's just optimal health, but liberalism promotes individual moral autonomy over traditional authority structures. If the laws have been modified such that dependent minors are now considered to have a legal right to privacy against their parents, that is a liberal development. Parents have authority over their children. They should have the right to know what their kids are up to.

If it's illegal and life-threatening, I'm more in favor of parents having a right to know. If they are a certain age and it pertains to everything else.... depends on what parents need to know. Try to put yourself in a 16 yr old's shoes, your lack of empathy will get you no where with patients. Try to encourage them to be open with their parents, remember that you are treating and doing what is best for the patient, not their parents. Decisions and education need to be tailored to the patients lifestyle and choices, whether you agree with them or not. That is the only way to ensure you are providing the best quality of care.

The overwhelming sense I got from my classmates when these topics were being discussed was the typical rebellious teenager attitude that parents are bad, they're clueless old fuddy-duddys who just don't understand the realities of life, they want to stop their kids from having fun, they are the enemy. These people's committment to sexual liberation is deeper than their commitment to health.

You are reading WAY too much into this. No one on god's green earth encourages sex at age 13. Again, you're forgetting that talking to patients can deter them from being sexually active and making behavioral decisions. There is no need for the second-coming of the chastity belt. You obviously didn't get the memo if you think physicians are the crusaders for teenage sexual liberation. Come on.

My objection here is that this is not presented as something you should investigate if you have a reason to suspect it; it's presented as routine "screening" that should be done to all patients. I understand if a woman comes in with bruises and her eyes get shifty if you ask here where they came from. But these people really believe that if a woman comes to the ER with a kidney stone and is accompanied by her husband, no matter how pleasant and apparently happy together they are, you need to kick the husband out of the room to ask the wife about domestic violence.

There's no medical reason to ask a happily married person whose presenting complaint has no association with any sexually transmitted disease or anything else sexual whether they have homosexual sex.
I said nothing about reporting abuse. What I am objecting to is attacking the foundations of civilized society by accusing men of whom one has no reason to suspect anything of wife-beating and child-molesting.
Oh, right, that must be why we were told "unfortunately, however much we all disagree with it, that is the law; it would be nice if the law weren't so destructive of society and we should work to change it, but for the time being, we must comply."

SERIOUSLY? It's not accusing, it's asking. When is asking personal (albeit awkward) questions about a patients life destructive to society? Signs of abuse are often non-existent, never assume anything. You will be surprised what information patients offer when asked. From a patient's perspective, I would want my physician to be concerned enough to ask me if I was having trouble with anything in my life. Wouldn't you?

 

[MattD]

Law2Doc:

As far as the adolescent be interviewed with parents out of the room. Do the parents have the right to be there or be informed about their childs needs and conditions especially since they are the financially responsible party? Don't they have some privilege as they are the parent of the minor and paying the bill?

You seem to be under the impression that your duties as a physician are simply an exchange of service for cash, and that therefore the person with the cash has the say. If a patient comes in and demands oxycontin for his sore thumb, are you going to prescribe it because, hey, he's the one paying the bill? You have ethical responsibilities to your patient and the profession that are unrelated to the financial considerations of who's paying. After all, I dont' think you REALLY believe what you're saying. The reason I say that is that the consequence includes something I don't think you'd support. Namely, a 14 year old coming in with her savings from her part time job, paying you in cash, and now, since SHE'S the one paying the bill, you can't tell her parents anymore! That's not what you're really saying, now is it?

 

[CigarTragic]

Reading this whole thread reminds me why I hate medical ethics discussions... because no matter what your answer is and what your reasoning behind your answer is, you're always WRONG. Hmmm... isn't med school fun?

 

[KrzyDOC]

I am surprised that your just pushed you into asking these questions without explaining why you would do wach of the tings you mentioned or were you just not paying attention in class? You should realy think about what you are learning and why it may be important for you to do these things even though you are not comfortable with them. This explains why so many teenagers have STDs and so many women are being abused. It is better to have a thorough doctor than a negligent one. Don't think you know what is the right thing to do when you are just in your first year, that is why you are in school learning how to be a doctor, If you would have known the right questions to ask on a history dont you think they wouldn't have the class.

 

[MattD]

Reading this whole thread reminds me why I hate medical ethics discussions... because no matter what your answer is and what your reasoning behind your answer is, you're always WRONG. Hmmm... isn't med school fun?

Heh, those of us who like to bicker love it though!

 

[Shredder]

I'm in my first year, and I admit it, I'm pretty unhappy so far. The reason is that I'm a stranger in a strange land. It seems like just about all of my classmates are blue-state, Volvo-driving, NPR-listening, New York Times-reading leftists who are passionate liberals on both "health" (i.e., socialized medicine, banning tobacco, taxing fatty foods, etc.) and general (same-sex marriage, abortion, taxes, etc.) issues. In addition, our school has a weekly seminar in which we've "learned" such gems as:

Academic institutions in general are liberal. Because they're part of the ivory tower. Much like liberals themselves they ignore realities of the world. I wish I went to a super right wing school, that would be amazing.

 

[CigarTragic]

Academic institutions in general are liberal. Because they're part of the ivory tower. Much like liberals themselves they ignore realities of the world.

Well put.

 

[la petite mort]

It just occurred to me that studying medicine in a tiny Roman-Catholic country where abortion is illegal means that I won't learn how to perform one. Will the rest of you get the chance?

I'm not pro-life or pro-choice either way, but I feel like I should be able to know how to do it.

 

[nogolfinsnow]

Academic institutions in general are liberal. Because they're part of the ivory tower. Much like liberals themselves they ignore realities of the world.

Please enlighten "liberals" as to which realities are being ignored.

 

[Tired]

Please enlighten "liberals" as to which realities are being ignored.

1) Ronald Reagan was the greatest president ever. We may be mistaken about that Jesus guy; Reagan well could be the messiah. He didn't actually die, he's waiting until the world needs him again, at which time he will return in a blaze of Hollywood glory.

2) Poor people are worthless. Poor people are also all minorities. There is no logical reason they should be paid for what little work they do.

3) Government subsidies are the reason for all the evil in the world. Except farm subsidies. And corporate tax breaks. And business tax credits. And repealing the estate tax. Basically, if it benefits people who make less than $80,000/yr, it's bad.

Duh.

 

[taurus70]

I'm laughing pretty hard about this field. I logged on in an aggravated mood just counting the days until my surgery core is finished and now I can't stop grinning. Ronnie Reagan, huh.

"The point is, ladies and gentlemen, that: Greed, for lack of a better word, is good. Greed is right; greed works. Greed clarifies, cuts through, and captures the essence of the evolutionary spirit. Greed, in all of its forms, greed for life, for money, for love, knowledge — has marked the upward surge of mankind and greed, you mark my words "

Gordon Gecko

P.S. Now I'm showing my age.

 

[MedGoatTX]

1) Ronald Reagan was the greatest president ever. We may be mistaken about that Jesus guy; Reagan well could be the messiah. He didn't actually die, he's waiting until the world needs him again, at which time he will return in a blaze of Hollywood glory.

2) Poor people are worthless. Poor people are also all minorities. There is no logical reason they should be paid for what little work they do.

3) Government subsidies are the reason for all the evil in the world. Except farm subsidies. And corporate tax breaks. And business tax credits. And repealing the estate tax. Basically, if it benefits people who make less than $80,000/yr, it's bad.

Duh.

count that

 

[CigarTragic]

1) Ronald Reagan was the greatest president ever. We may be mistaken about that Jesus guy; Reagan well could be the messiah. He didn't actually die, he's waiting until the world needs him again, at which time he will return in a blaze of Hollywood glory.

2) Poor people are worthless. Poor people are also all minorities. There is no logical reason they should be paid for what little work they do.

3) Government subsidies are the reason for all the evil in the world. Except farm subsidies. And corporate tax breaks. And business tax credits. And repealing the estate tax. Basically, if it benefits people who make less than $80,000/yr, it's bad.

Duh.

Oh. Real funny.

Please, go on one of those rants about how all conservative white males are rich, racist, and "sheltered", especially if they grew up in the suburbs (as if they had any choice in that matter). And God forbid they open their mouths or try to lead when things go awry, they must be chauvinistic and on a power trip, right? Oh and also, let's not forget about just how ignorant and dumb they are, especially if they grew up Christian.

Please, Enlightened One, educate us. After all, we're all just a bunch of selfish, uneducated, close-minded, affluent, intolerant Puritans.

 

[bellacnella]

.

 

[Blesbok]

TS is right

1) We need to stop giving kids contraceptives, because kids having kids is fun.
b) We need to stop asking questions, instead we should just assume.
III) We should stop telling people that they need to quit smoking. There haven't been enough definitive studies on the subject to make that kind of assertion.

 

[Biscuit799]

Please enlighten "liberals" as to which realities are being ignored.

1) Health Care access is a non-issue. I challenge anyone to come up with a real world example where a patient has been turned away because of lack of ability to pay. It doesn't happen. The real rate-limiting step is availability of physicians. The less free market you allow in health care, and the more obstacles you put in front of reimbursement, the less physicians will be available.

2) Free trade, low taxes, and eliminating barriers to commerce boost economies. This is a well documented fact that appears over and over both in history and in academic papers. Countries that do well economically have cleaner environments, less poverty, and less crime. Likewise countries with poor economies who grow economically become cleaner and more peaceful. Working people are happy people.

3) People have varying positions on social issues, and an individual's morality, personal experience, and level of "compassion" all influence their positions on social issues. Thus 10 different people will have 12 different opinions, all with sound arguments. Thus, you cannot legislate good will, open-mindedness, and social welfare. Government is NOT the forum for social issues. Conversely, ethnic groups that did not seek equalization through government avenues accommodated and acculturated better than their counterparts.

This is not hard stuff, and is pretty apparent to most people with sense.

 

[andtheholograms]

1) Health Care access is a non-issue. I challenge anyone to come up with a real world example where a patient has been turned away because of lack of ability to pay. It doesn't happen.

Granted, people don't get turned away (usually). But access to care doesn't mean just getting to the door and walking in. It includes all the barriers to care along the way:

What about the working poor? Yes, absolutely we all have access to the ER and health department, if we also have the flexibility in our jobs to take off the unknown amount of hours it'll take to wait for that care. But what if that flexibility isn't there? If you are living paycheck to paycheck, that 5 or so hours off to wait in the ER may mean the difference between having food or not.

Or, again, maybe to get to the hospital/free clinic (outside of an emergency situation), you need to take the bus--add in that waiting time as well (I'm in Tampa, the buses are pretty irregular--I've routinely waited up to an hour).

God forbid you be a working single mom with kids--try taking that time off work when your kids are sick to head to the ER for 8 hours at a time to get their ear infections treated, especially as an hourly worker.


There are a million examples of people being unable to access health care. Health care professionals tend to view access to health care in terms of people being able to pay for services, forgetting that health itself is part of a continuum that includes healthy bodies, availability of and access to healthy foods, safe places to exercise, mental health care and lack of institutional violence.

 

[riverwoman1040]

1) Health Care access is a non-issue. I challenge anyone to come up with a real world example where a patient has been turned away because of lack of ability to pay. It doesn't happen. The real rate-limiting step is availability of physicians. The less free market you allow in health care, and the more obstacles you put in front of reimbursement, the less physicians will be available.

Real word example- I have crappy temporary insurance until I start med school. It doesn't cover anything, and I'm not making a ton of money right now. Consequently, I have put off my annual physical because I can't afford it right now. I haven't gotten vaccinations that would be smart for me to get because I can't afford them. It's probably not going to cause problems for me, but for a lot of people it could. Why wait until they end up in the ER.

Also, I was diagnosed with a medical condition about 6 months ago, while I was under different insurance. It is a "pre-existing condition" and my insurance will not pay for any associated costs. It has gotten worse, to the point where without treatment, I would have a hard time doing my job. With treatment, I'm perfectly healthy, but if my parents weren't able (or willing) to foot the bill for my specialist there is no way I could afford to be treated. and I have insurance...

I can't believe anyone actually think that access is a non-issue?!?! If it's an issue for a college grad with health insurance, how could it not be an issue for those who are less fortunate?

 

[Biscuit799]

Real word example- I have crappy temporary insurance until I start med school. It doesn't cover anything, and I'm not making a ton of money right now. Consequently, I have put off my annual physical because I can't afford it right now. I haven't gotten vaccinations that would be smart for me to get because I can't afford them. It's probably not going to cause problems for me, but for a lot of people it could. Why wait until they end up in the ER.

Also, I was diagnosed with a medical condition about 6 months ago, while I was under different insurance. It is a "pre-existing condition" and my insurance will not pay for any associated costs. It has gotten worse, to the point where without treatment, I would have a hard time doing my job. With treatment, I'm perfectly healthy, but if my parents weren't able (or willing) to foot the bill for my specialist there is no way I could afford to be treated. and I have insurance...

I can't believe anyone actually think that access is a non-issue?!?! If it's an issue for a college grad with health insurance, how could it not be an issue for those who are less fortunate?

1) As a routine office visit is not terribly expensive, it is rarely the case that an individual cannot afford routine care. Thus, most routine care can be afforded by foregoing a few nights out to eat, or not upgrading a television set. And as vaccinations are a once in ten years type of expense, and are also rarely more than a hundred bucks or so (not to mention you'll usually get a discount on everything by paying cash), it is again, unlikely that an individual cannot afford such expenditures. And as all purchases are a reflection of choice and personal value of the service, it is not unreasonable to hold individuals accountable for those choices.

2)Pre-existing conditions are generally not covered for a window, but are then picked up after a certain time period has elapsed (12 months max according to Title 1 of HIPAA). That time period can be reduced if the individual had health insurance previous to changing carriers. Check with you individual plan.

3) As a young adult, health insurance plans are not terribly expensive. In Florida (a pretty awful state as far as premiums are concerned), a no frills plan can cost someone in their 20's from$50-150/month. Premiums go up as you age, but pretty much all plans stipulate that premiums will not increase as long as you continue to renew your plan. So as long as a person buys and maintains coverage, their health care will remain relatively inexpensive. Not buying coverage is again an individual's choice and they are again responsible for that decision.

4) Thus, the vast majority of those who are not covered are either a) people who choose to not carry coverage, which mainly consist of young people who's jobs don't cover them and who view coverage as too expensive, or b) people who have recently lost coverage by losing a job. The latter is generally covered by COBRA, while the former is again an individual's choice.

5) The main reason for the high cost of care as a system is a combination of needless testing to avoid catastrophic malpractice awards, the reckless pursuit of perfection when we are so far up the marginal cost curve that every additional minute of life we save could buy your favorite pro baseball team a clean up hitter, and a complete separation of consumers of care and payers.

While there are certainly inherent problems in the system, and it is without a doubt not perfect, the major factor in healthcare is how much an individual cares about their health. This is a problem that will not be fixed by forcing healthcare on everyone, or by "giving" healthcare away for "free." Not to mention that in countries with single-payer/socialized systems, coverage is rationed to an extent that the American voter would never stand for, making it completely impractical for American society.

 

[riverwoman1040]

1) As a routine office visit is not terribly expensive, it is rarely the case that an individual cannot afford routine care. Thus, most routine care can be afforded by foregoing a few nights out to eat, or not upgrading a television set. And as vaccinations are a once in ten years type of expense, and are also rarely more than a hundred bucks or so (not to mention you'll usually get a discount on everything by paying cash), it is again, unlikely that an individual cannot afford such expenditures. And as all purchases are a reflection of choice and personal value of the service, it is not unreasonable to hold individuals accountable for those choices.

2)Pre-existing conditions are generally not covered for a window, but are then picked up after a certain time period has elapsed (12 months max according to Title 1 of HIPAA). That time period can be reduced if the individual had health insurance previous to changing carriers. Check with you individual plan.

3) As a young adult, health insurance plans are not terribly expensive. In Florida (a pretty awful state as far as premiums are concerned), a no frills plan can cost someone in their 20's from$50-150/month. Premiums go up as you age, but pretty much all plans stipulate that premiums will not increase as long as you continue to renew your plan. So as long as a person buys and maintains coverage, their health care will remain relatively inexpensive. Not buying coverage is again an individual's choice and they are again responsible for that decision.

4) Thus, the vast majority of those who are not covered are either a) people who choose to not carry coverage, which mainly consist of young people who's jobs don't cover them and who view coverage as too expensive, or b) people who have recently lost coverage by losing a job. The latter is generally covered by COBRA, while the former is again an individual's choice.

5) The main reason for the high cost of care as a system is a combination of needless testing to avoid catastrophic malpractice awards, the reckless pursuit of perfection when we are so far up the marginal cost curve that every additional minute of life we save could buy your favorite pro baseball team a clean up hitter, and a complete separation of consumers of care and payers.

While there are certainly inherent problems in the system, and it is without a doubt not perfect, the major factor in healthcare is how much an individual cares about their health. This is a problem that will not be fixed by forcing healthcare on everyone, or by "giving" healthcare away for "free." Not to mention that in countries with single-payer/socialized systems, coverage is rationed to an extent that the American voter would never stand for, making it completely impractical for American society.

1. You don't seem to understand how hard it can be for some people to live on what they make. I have parents who help me out, so I'm doing ok, but not everyone does. Even with financial help I don't own a TV, almost never go out to eat (I make the rare exception for friends birthdays), haven't bought new clothes for myself in a good year in a half, bike to work so I don't have to pay for gas, live in a crappy apartment, my main form of entertainment is the public library, etc. Now try doing this while raising a kid or 3... I have met plenty of families who legitimately cannot afford to live on their salaries, and it's not just that they're wasting money. Do you really not believe that these people are out there? If so, you really should consider getting out of upper-middle class suburbia, beverly hills, or wherever you live. If you're making minimum wage, 40 hours per week a hundred bucks or so is a decent chunk of your salary. Heck, it's food for a few weeks. If it comes down to vaccine or food for your family, which would you pick?

2. Pre-existing conditions may only exist for a window, but try having a serious health issue for 12 months and not being able to deal with it. Then try losing your job because of it. I'm not going to elaborate, but this easily could have happened to me if I didn't have someone helping me out.

3. I said this before, but I'll repeat it. I had health insurance. I did not make a choice to risk it. Instead, I happen to live in a country where we allow health insurance companies to not pay our hospitals for services. Consequently, I had a $1500 bill show up the other day for something that happened while I had health insurance. If you really don't believe I can't afford this I'll pm you my bank statement for the month and you can find the funds

4. Ever looked into the costs of COBRA? My roommate was going to have to pay $350/month for it when she was between jobs. Again, if you can find an extra $350/month in my paycheck, I'd love your help.

I agree that a single payer system would be disasterous here, and I totally understand the view that universal coverage isn't feasible in our country. However, to say that everyone has access to healthcare is absurd. Even politicians don't argue over this. When did the idea that bad things happen to good people come into questino?

 

[Biscuit799]

When did the idea that bad things happen to good people come into questino?

This point never came up, I never implied such, and to suggest I did is to completely misrepresent what I'm saying.

I'm not denying that there are legitimate circumstances in which people cannot afford needed healthcare. My point, however, was that this represents a minority of the uninsured. As I said before, the vast majority make a conscious decision to not finance their own healthcare.

(I grew up with much less than the vast majority of my classmates, which is probably the reason I'm more laissez-faire than the ivory tower comrades that inhabit the seats around me)

I do not know the specifics of your situation. Apparently you have a long term, debilitating condition that merits constant medical surveillance, and had a situation arise where you could not afford care. If the situation is as difficult as it seems, then that would enter into a whole other realm of financing of which I am not familiar. I'm sorry your health insurance rejected a claim, and I'm sure there are thousands of others who have experiences similar to yours. As I said, it's not a perfect system. As you said yourself, you were insured when this problem arose.

(Also, if you lost your job because of a legitimate medical complaint, that enters into a whole realm of legal issues which, if it is indeed as straightforward as you imply, I would recommend seeking legal counsel)

According to wikipedia, COBRA costs include the original premium plus the remainder which the employer previously payed. Considering that the cost of employer health coverage is a form of reimbursement, and if it weren't offered, one's salary would be higher, it can be argued that the health insurance costs exactly the same after COBRA as it did before.

Again, it is not a perfect system. However, both hospitals and doctors offices eat tremendous costs associated with providing care for those who will never pay for it. If someone has an event for which they need treatment, I would doubt a hospital or physician would turn them away (and this doesn't even count the community health clinics that inhabit every county in the country) and let them die. This leads me back to my original point that while health care is an issue, it certainly does not deserve the attention it gets from political pundits and talking heads on CNN. Healthcare has been an issue in approximately the past 10 elections. It cannot be a "crisis" if it goes on for 40 years.

(perhaps I exaggerated when I said "non-issue," however it is a small issue at best)

 

[tianxia08]

I'm in my first year, and I admit it, I'm pretty unhappy so far. The reason is that I'm a stranger in a strange land. It seems like just about all of my classmates are blue-state, Volvo-driving, NPR-listening, New York Times-reading leftists who are passionate liberals on both "health" (i.e., socialized medicine, banning tobacco, taxing fatty foods, etc.) and general (same-sex marriage, abortion, taxes, etc.) issues. In addition, our school has a weekly seminar in which we've "learned" such gems as:

• When seeing an adolescent patient, it's important to kick their parents out of the room so you can talk to them about their sexual activity and offer them contraception without their parents' knowledge
• When seeing a female patient, it's important to ask her if she feels "safe at home" (i.e., accuse her husband, excuse me, "partner," of beating her)
• A complete medical history includes a sexual history, and its' essential to ask the patient whether they are active with "men, women, or both" (even if it's a 75-year-old widow)

Of course, if the purpose of this is to liberalize us, it's pointless since all of my classmates except me are already 100% on board with it.

I know we live in a basically liberal society, but I didn't expect it to be this bad. I thought there might be some of this stuff in the air around me, this being a university and all, but it would be easy to just shrug it off and concentrate on studying medicine. But it's proven very demoralizing; it's hard to hunker down and study biochem pathways when you're constantly being reminded that all of your future colleagues, and even the very profession you're entering as a whole, are hell-bent on destroying Western civilization.

Are there any schools where it's not like this? Is anyone else in this situation, or is everyone reading this thread of the same mind as my classmates (i.e., thinking I'm an evil bigoted oppressive white male who fortunately is having the page of history turned on him and will soon die out as we usher in the glorious brave new world of global UN rule?)

medical world

 

[MattD]

1) As a routine office visit is not terribly expensive, it is rarely the case that an individual cannot afford routine care. Thus, most routine care can be afforded by foregoing a few nights out to eat, or not upgrading a television set. And as vaccinations are a once in ten years type of expense, and are also rarely more than a hundred bucks or so (not to mention you'll usually get a discount on everything by paying cash), it is again, unlikely that an individual cannot afford such expenditures. And as all purchases are a reflection of choice and personal value of the service, it is not unreasonable to hold individuals accountable for those choices.

Wow. The poor people you know aren't like the poor people I know........

If the people you're talking about can afford ANY nights out to eat, or HAVING a tv set, you're not talking about the same people I think the others are talking about.

I had a patient today wait 5 hours at our free clinic for 10 bucks worth of meds. He had a back pack with him that held, from the look of it, all his $hit. And by all his $hit, I mean ALL his $hit. I see about a dozen patients a week in this situation. And it's not the same ones every week. Think about it.

 

[Slide]

Wow. The poor people you know aren't like the poor people I know........

If the people you're talking about can afford ANY nights out to eat, or HAVING a tv set, you're not talking about the same people I think the others are talking about.

I had a patient today wait 5 hours at our free clinic for 10 bucks worth of meds. He had a back pack with him that held, from the look of it, all his $hit. And by all his $hit, I mean ALL his $hit. I see about a dozen patients a week in this situation. And it's not the same ones every week. Think about it.

I've seen similar situations too like this when I work at the free clinic sometimes. To me it was a little messed up when we were giving a stroke patient his prescription and whether he could get them or not was dependent on his daughter (who was definitely younger than me) being able to afford it. I just love it when people use the word "ivory tower" on others and they themselves are just as sheltered and removed from their "comrades".

 

[45408]

4. Ever looked into the costs of COBRA? My roommate was going to have to pay $350/month for it when she was between jobs. Again, if you can find an extra $350/month in my paycheck, I'd love your help.

Don't bother with COBRA. I sure didn't. I got a disaster-coverage plan for the time after I got married but before my wife's coverage kicked in, and it was $165 per quarter.

 

[45408]

Wow. The poor people you know aren't like the poor people I know........

If the people you're talking about can afford ANY nights out to eat, or HAVING a tv set, you're not talking about the same people I think the others are talking about.

I had a patient today wait 5 hours at our free clinic for 10 bucks worth of meds. He had a back pack with him that held, from the look of it, all his $hit. And by all his $hit, I mean ALL his $hit. I see about a dozen patients a week in this situation. And it's not the same ones every week. Think about it.

Yes, those people are poor. However, there are PLENTY of other people who personally consider themselves poor but actually are not. CASE IN POINT - http://michellemalkin.com/2007/12/2...-woman-is-the-slum-dweller-with-a-60-inch-tv/

People like her are the ones I have a problem with. I am not opposed to helping those who are truly in need, but I do have an enormous problem with helping those who have no desire to help themselves, despite the obvious ability to do so. It's only insult to injury when these people then claim that they are somehow getting held down by the man.

 

[Biscuit799]

Wow. The poor people you know aren't like the poor people I know........

If the people you're talking about can afford ANY nights out to eat, or HAVING a tv set, you're not talking about the same people I think the others are talking about.

I had a patient today wait 5 hours at our free clinic for 10 bucks worth of meds. He had a back pack with him that held, from the look of it, all his $hit. And by all his $hit, I mean ALL his $hit. I see about a dozen patients a week in this situation. And it's not the same ones every week. Think about it.

I spent a month working with a home-health care facility in Thomasville, GA. We went and saw nothing but Medicaid patients in places called Oklochnee, Cairo, Moultrie; who lived on roads called "Egg Butter Rd, etc." These poor people make every other poor person in the country look like tobacco plantation owners. And yes, the vast majority were making decisions not to purchase health care, as the vast majority of those without coverage do. There were a great deal of in need individuals. However I don't feel sorry for someone who smokes a pack a day, has jewelry falling of their neck (and teeth), and own cell phones. I saw a dozen patients a day in this situation.

Think about it.

 

[riverwoman1040]

1) Health Care access is a non-issue. I challenge anyone to come up with a real world example where a patient has been turned away because of lack of ability to pay. It doesn't happen. The real rate-limiting step is availability of physicians. The less free market you allow in health care, and the more obstacles you put in front of reimbursement, the less physicians will be available.

I'm not denying that there are legitimate circumstances in which people cannot afford needed healthcare. My point, however, was that this represents a minority of the uninsured. As I said before, the vast majority make a conscious decision to not finance their own healthcare.

Maybe I misunderstood you, but it seems that saying it's a "non-issue" is the same as saying that there are not legitimate circumstances in which people cannot afford needed healthcare. This was further reinforced when you challened people to provide a real world example. By saying that people who can't afford healthcare should just give up going out to eat, or upgrading a TV it seemed that you were suggesting that all people who could not afford healthcare were in that position because of their own choices. Hence, (and I don't think this is a huge stretch) bad things happen to people who make bad choices. I fully agree that there are plenty of people out there who are not willing to work for things. I agree that we shouldn't be letting these people sit around while we pay to take care of them. What I didn't agree with was the idea that everyone who can't afford healthcare fits into this category.

As for my own situation, everything is fine. It was somewhat debilitating, but because I was fortunate enough to have parents who could pay for my treatment, it was treated and is no longer a long term issue. I did not lose my job. I was merely using my own situation to illustrate what could happen to someone in the same position who didn't have someone to bail them out. Luckly, I did and now I'm perfectly healthy. The thousands of others you refer to are the reason that healthcare is an issue.

COBRA may sound great to you in theory, but I've known plenty of people who have tried it, and it just doesn't work out well. I actally got a letter from my last employer saying that if I wanted to continue my coverage it would be over $500/month (it was great insurance) I went with short term coverage. The trade off is that it's crappy insurace. If you're healthy and nothing major comes up its great. It's cheap, you can set the number of days you need it for.

 

[Slide]

Maybe I misunderstood you, but it seems that saying it's a "non-issue" is the same as saying that there are not legitimate circumstances in which people cannot afford needed healthcare. This was further reinforced when you challened people to provide a real world example. By saying that people who can't afford healthcare should just give up going out to eat, or upgrading a TV it seemed that you were suggesting that all people who could not afford healthcare were in that position because of their own choices. Hence, (and I don't think this is a huge stretch) bad things happen to people who make bad choices. I fully agree that there are plenty of people out there who are not willing to work for things. I agree that we shouldn't be letting these people sit around while we pay to take care of them. What I didn't agree with was the idea that everyone who can't afford healthcare fits into this category.

The last part is a pretty good point. A lot of us here seem to agree on the issue that there are people that honestly can't afford health care or are constrained to have to pick between health care and other commodities like gas, loan payments, etc., and these are the people we should try to help (which is much more of the middle class than some others of this forum would like to believe). Then there are some others that don't want to pay for health care because they prefer to buy unessential luxuries like a plasma tv or the newest car out there, and it's these people that have what's coming to them. What to me is the issue is how we try to approach this issue, and whether we should address the issue by lumping those that can't afford the health care into the latter category.

EDIT: Here's an example of a person being turned away from primary medical care. Granted, this is more of an issue of medicare, but here's an example. She can ultimately get care from an ED department, but this is kinda ridiculous.
http://www.youtube.com/watch?v=pGTqqQkMIDU

 

[NoMind]

A complete medical history includes a sexual history, and its' essential to ask the patient whether they are active with "men, women, or both" (even if it's a 75-year-old widow)

I think your medical school is lacking. I think any good health screening should include these questions as well as more pointed questions about beastiality and other such disciplines. You ever heard of echinococcus, strep bovus, TOXOPLASMOSIS???!!!

 

[Biscuit799]

Maybe I misunderstood you, but it seems that saying it's a "non-issue" is the same as saying that there are not legitimate circumstances in which people cannot afford needed healthcare. This was further reinforced when you challened people to provide a real world example. By saying that people who can't afford healthcare should just give up going out to eat, or upgrading a TV it seemed that you were suggesting that all people who could not afford healthcare were in that position because of their own choices. Hence, (and I don't think this is a huge stretch) bad things happen to people who make bad choices. I fully agree that there are plenty of people out there who are not willing to work for things. I agree that we shouldn't be letting these people sit around while we pay to take care of them. What I didn't agree with was the idea that everyone who can't afford healthcare fits into this category.

As for my own situation, everything is fine. It was somewhat debilitating, but because I was fortunate enough to have parents who could pay for my treatment, it was treated and is no longer a long term issue. I did not lose my job. I was merely using my own situation to illustrate what could happen to someone in the same position who didn't have someone to bail them out. Luckly, I did and now I'm perfectly healthy. The thousands of others you refer to are the reason that healthcare is an issue.

COBRA may sound great to you in theory, but I've known plenty of people who have tried it, and it just doesn't work out well. I actally got a letter from my last employer saying that if I wanted to continue my coverage it would be over $500/month (it was great insurance) I went with short term coverage. The trade off is that it's crappy insurace. If you're healthy and nothing major comes up its great. It's cheap, you can set the number of days you need it for.

The point that I was attempting, via exaggeration, to make is that health care hardly deserves a front page column and daily reports on MSNBC. I believe that the situation is not nearly as bad as Hillary Clinton would have you believe, and there are droves of people out there who, if not given healthcare coverage for "free," would not have it by choice, and that these individuals make up the majority of the uninsured. I have no problem holding people to bad decisions, just as in every other aspect of life.

The challenge was to illustrate an example of an individual denied care due to an inability to pay. Your example was forgoing a physical and needed vaccinations. You ended up being perfectly fine, however, had you had an acute problem, you could have gone to any ER which would have treated you (as nobody is going to let you, or anyone else, die). They also would have admitted you, and the local hospitalists would have seen you. I see situations like this every day at the hospital I work in. Had you been unable to pay the ER, the hospital, or the docs, they all would have eaten the costs. As nothing acute or bad happened to you, I guess we'll just never know for sure (which is a good thing).

I think in the end, we agree more than we disagree. I guess I just used poor word choice. Instead of non-issue, I'll change it to minor issue. Unfortunately bad things happed to good people, people who have insurance end up getting caught in red tape, transitions between jobs complicate the situation (we can argue all day about whether or not an employer based system is a good thing), and prenatal and child care are a whole other issue (as I believe no child should suffer due to a neglectful/unhealthy/etc parent). Again, it's not a perfect system.

 

[MattD]

I spent a month working with a home-health care facility in Thomasville, GA. We went and saw nothing but Medicaid patients in places called Oklochnee, Cairo, Moultrie; who lived on roads called "Egg Butter Rd, etc." These poor people make every other poor person in the country look like tobacco plantation owners. And yes, the vast majority were making decisions not to purchase health care, as the vast majority of those without coverage do. There were a great deal of in need individuals. However I don't feel sorry for someone who smokes a pack a day, has jewelry falling of their neck (and teeth), and own cell phones. I saw a dozen patients a day in this situation.

Think about it.

Is the jewelry falling off their teeth, or the teeth falling out of their mouth? ;-)

hey, I'm not trying to say that the majority of people in that situation aren't there because of poor choices. I'm also not going to get into a discussion of socio-cultural-economic factors that drive many of those decisions. And I'm certainly not trying to get into a 'whose patient population is poorer' pissing match. All I'm saying is that there are plenty of people, who regardless of what path their lives took to get where they are, do not have a legitimate means of paying for health care in the here and now. Maybe they were crackheads, sex workers, criminals, or whatever, and made horrible horrible choices to get where they are. Maybe they're trying to repair those mistakes and turn their lives around, maybe they're not. Maybe they'll succeed, maybe they won't. Regardless, many of them cannot afford care for the problems they have today. Some people would say too bad, they made their choices and these are the consequences, and that's their right to think that and it's probably a fair position. However, it doesn't change the fact that for that patient, health care access is an issue. Which is all I'm trying to say

 

[MattD]

Yes, those people are poor. However, there are PLENTY of other people who personally consider themselves poor but actually are not. CASE IN POINT - http://michellemalkin.com/2007/12/2...-woman-is-the-slum-dweller-with-a-60-inch-tv/

People like her are the ones I have a problem with. I am not opposed to helping those who are truly in need, but I do have an enormous problem with helping those who have no desire to help themselves, despite the obvious ability to do so. It's only insult to injury when these people then claim that they are somehow getting held down by the man.

I totally agree.

 

[bellacnella]

I too have seen pts. on welfare and medicaid driving BMW's, on bluetooths, etc. It can be disheartening.

But I know personally that health insurance is an issue for most.

Even as a soon to be college grad, I don't have health insurance. Unfortunately, I developed an ear infection which I cant even get seen about...now I have to wait 3 weeks to get looked at for free whilst I walk around with clicking in my ear. Does that warrant going to the ER? I do not live in luxury either and I work 2 jobs with no benefits.. I do not own a cellphone and my car is used and falling apart, and I need to get it fixed since it failed inspection. I am hoping it makes it through the next couple of weeks so I can finish my undergrad degree. To make matters worse, I am sort of sleeping on someone's couch until August...

So I think it is in part a matter of ignorance, due to a lack of perspective. Poor is poor. If someone can't afford healthcare, then they just can't afford it. Some of the statements on this thread just indicate a lack of knowledge about how people live, probably because they never had to struggle like that.

 

[Tired]

Unfortunately, I developed an ear infection which I cant even get seen about...now I have to wait 3 weeks to get looked at for free whilst I walk around with clicking in my ear. Does that warrant going to the ER?

I love this, because even smart people are stupid when it comes to health care.

#1 - "Going to the ER" does not equal "getting treated for free". They will send you a bill. And if you don't pay, it will go to collections.

#2 - If you want to get treated, tell them you will pay cash. It will be like $80-100. You can't swing that?

 

[bellacnella]

I love this, because even smart people are stupid when it comes to health care.

#1 - "Going to the ER" does not equal "getting treated for free". They will send you a bill. And if you don't pay, it will go to collections.

#2 - If you want to get treated, tell them you will pay cash. It will be like $80-100. You can't swing that?

How am I being stupid about my health care?

#1- That's what I am saying. We do not disagree. My point was that the "free" clinic is booked for the next few weeks. I am not going to go to the ER when they will just bill me for a ****load of money and mess up my credit. I never said going to the ER was being treated for free.

#2- No, not if I want to get to school for the next few weeks and graduate. I am having hard times right now...Or else why would I be walking around unable to hear out of one ear? The point is I actually have to decide, am I going to wait this out and finish commuting or drop $100 to have this looked at. Before someone rips me a new one, I do work as a TA and work study but that ran out so I am in a bind. And trust me the economy sucks right now as far as the job market is concerned. (My parents dont take care of me).

 

[MattD]

I love this, because even smart people are stupid when it comes to health care.

#1 - "Going to the ER" does not equal "getting treated for free". They will send you a bill. And if you don't pay, it will go to collections.

#2 - If you want to get treated, tell them you will pay cash. It will be like $80-100. You can't swing that?

Not all of us are living the resident's salary high life ya' know :-D