Comments on Scalpel or Sword?: Spreading the Wealth

Anon writes: "so many good men have died in battle...

2008-11-05T11:57:00.000-06:00

Anon writes: "so many good men have died in battle to defend democracy and a free market economy..."

To die for love of country, liberty, family, home, democracy, God, and a million other things, sure. But the free market economy? When have Americans been asked to give their lives to safeguard the free market economy?

Anonymous 08:39,"Don't tell me I don't know what s...

2008-11-04T21:17:00.000-06:00

Anonymous 08:39,

"Don't tell me I don't know what satire is. I'm working on a degree in literature."

From the OED
Satire
"I. 1. A poem, or in modern use sometimes a prose composition, in which prevailing vices or follies are held up to ridicule. Sometimes, less correctly, applied to a composition in verse or prose intended to ridicule a particular person or class of persons, a lampoon."

I guess that is my example of irony. :-)

Its disturbing to think so many good men have died...

2008-11-04T20:57:00.000-06:00

Its disturbing to think so many good men have died in battle to defend democracy and a free market economy to only have that entity the defended elect someone who is in direct contradiction of their purpose of service.

As for the ER, I agree. But with a nationalized healthcare system you may now be required to dedicate some of your time to other services. Hell the ER may just shut down or worse, be run by surgery...!

Your opening, which the rest of the "satire" rides...

2008-11-04T20:39:00.000-06:00

Your opening, which the rest of the "satire" rides on:

"Since it appears that America is headed towards obligatory Socialism courtesy of our imminent Democrat overlords..."

This is more Sarcasm than it is "satire". And if it is satire, it is still mocking socialist/democratic ideals. Therefore anyone who disagrees with you is justified. Don't tell me I don't know what satire is. I'm working on a degree in literature. I know full well what satire is. This post was having fun at the expense of Obama supporters, and is laced with your opinions.

Like most conservatives, scalpel fails to understa...

2008-11-03T15:21:00.000-06:00

Like most conservatives, scalpel fails to understand that "being a prick" is not equal to "satire".

I think you're on to something. You may have figu...

2008-11-03T15:16:00.000-06:00

I think you're on to something. You may have figured out the only way to make universal coverage work. (Said a Dem who's not buying the party line on health coverage. I'm still voting Obama, though, all things considered.)

The ER is an impossible situation. We do our best...

2008-11-03T15:05:00.000-06:00

The ER is an impossible situation. We do our best to make things work as well as they can work, given the impossible ratio of unlimited need to highly limited resources.

And this is just my point. If one were to choose to provide extra attention to some patients (whipped cream and a cherry) in a situation where cutting corners is the unfortunate but necessary norm, then medical necessity had better be the primary determinant of who gets extra attention.

So then we are back to Mr. Klein's assertion that the ED "parcels out medical attention based on severity of condition rather than thickness of wallet, thus fulfilling the 'to each according to his need' requirement. It's a socialists redoubt in a capitalist system."

In the ED situation, the doc who looks to ability to pay rather than medical necessity in determining the allocation of his limited resources of time and energy is not unlikely to be running into conflict with the rules of medical ethics.

Residency is sort of an artificial situation. In t...

2008-11-02T21:04:00.000-06:00

Residency is sort of an artificial situation. In the real world, without anyone looking over their shoulder, many of your former residents are listening to half a sentence before interrupting and plowing on to the abbreviated and cursory physical exam and inevitable CT scan. They usually leave the re-assessments to the nurses, and they may or may not give verbal discharge instructions.

When pressed for time, most of us cut corners a bit. Where and how much we cut them vary considerably.

In my EW we've found that listening to the patient...

2008-11-02T16:04:00.000-06:00

In my EW we've found that listening to the patients has been a necessary precondition to accurate diagnosis and appropriate treatment.

My residents who try to manage their patients without listening to them tend not to fare too well.

My residents had better offer explanations that are detailed enough to obtain an adequately informed consent from every patient.

If these are the whipped cream and a cherry on top of treatment then they better be on every cup that is provided. The doc who doesn't listen and doesn't inform is putting their license and livelihood at risk, to say nothing of ethical responsibilities.

I don't see anything there about adding whipped cr...

2008-11-02T14:54:00.000-06:00

I don't see anything there about adding whipped cream with sprinkles and a cherry on top.

When incentive is taken away by socialism, eventually some docs may decide to dispense with the hand-holding, with the listening, with the detailed explanations, with the TLC that separates the exceptional physician from the average.

And yet they may still be basically competent and perfectly ethical. Just not exceptional.

Just be sure, when you're deciding whether to give...

2008-11-02T14:39:00.000-06:00

Just be sure, when you're deciding whether to give your patient swiss miss or flanders cocoa that you're not running afoul of these. (Some of your assertions lead me to suspect that you may be):

I. PRINCIPLES OF ETHICS FOR EMERGENCY PHYSICIANS

The basic professional obligation of beneficent service to humanity is expressed in various physicians' oaths and codes of ethics. In addition to this general obligation, emergency physicians accept specific ethical obligations that arise out of the special features of emergency medical practice. The principles listed below express fundamental moral responsibilities of emergency physicians.

Emergency Physicians Shall:

1. Embrace patient welfare as their primary professional responsibility.
2. Respond promptly and expertly, without prejudice or partiality, to the need for emergency medical care.
3. Respect the rights and strive to protect the best interests of their patients, particularly the most vulnerable and those unable to make treatment choices due to diminished decision-making capacity.
4. Communicate truthfully with patients and secure their informed consent for treatment, unless the urgency of the patient's condition demands an immediate response.
5. Respect patient privacy and disclose confidential information only with consent of the patient or when required by an overriding duty such as the duty to protect others or to obey the law.
6. Deal fairly and honestly with colleagues and take appropriate action to protect patients from health care providers who are impaired or incompetent, or who engage in fraud or deception.
7. Work cooperatively with others who care for, and about, emergency patients.
8. Engage in continuing study to maintain the knowledge and skills necessary to provide high quality care for emergency patients.
9. Act as responsible stewards of the health care resources entrusted to them.
10. Support societal efforts to improve public health and safety, reduce the effects of injury and illness, and secure access to emergency and other basic health care for all.

"Every man cannot have his way in all things. If h...

2008-11-02T12:24:00.000-06:00

"Every man cannot have his way in all things. If his opinion prevails at some times, he should acquiesce on seeing that of others preponderate at other times. Without this mutual disposition we are disjointed individuals, but not a society." -- Thomas Jefferson to J. Dickinson, 1801.

What scalpel doesn't understand is that Bush has n...

2008-10-31T19:39:00.000-05:00

What scalpel doesn't understand is that Bush has never been a fiscal conservative in the true sense of the word. Bill Clinton was much more fiscally conservative than Bush ever was. Yes it is truly hard to give a tax cut to the wealthy and ignore a ballooning deficit via writing IOU's to the chinese. I honestly believe scalpel wouldn't know a true fiscal conservative or liberal if it bit him in the ass. Just as long as it happens to where the republican sticker, it is good enough for him. What a non-thinking ideologue

I expected a few more visitors from that link. I g...

2008-10-31T19:36:00.000-05:00

I expected a few more visitors from that link. I got more referrals from Dr. WhiteCoat when he first linked to this post.

Whitecoat, you should tap into some of those sweet advertising bucks.

Anonymous 04:25,You make my point and seem not to ...

2008-10-31T17:55:00.000-05:00

Anonymous 04:25,

You make my point and seem not to understand the dufference between liberal and literal.

Cranky,

At least dancing pigs help me to feel that I can dance.

Anonymous 0525,

You understand satire and understand that the best way to respond to satire is with satire. You made me laugh.

God can only hope these douche jockeys are not bre...

2008-10-31T17:29:00.000-05:00

God can only hope these douche jockeys are not breeding.

One of the best ways to determine the quality of s...

2008-10-31T17:25:00.000-05:00

One of the best ways to determine the quality of satire is the outrage in responses from those with different points of view.

Okay!

Ah, Rogue Medic...arguing with such people is like...

2008-10-31T17:00:00.000-05:00

Ah, Rogue Medic...arguing with such people is like putting lipstick on a pig, and then trying to teach it to dance.

You get frustrated, and chances are, the pig gets off on it.

wow, if that was satire, it was really bad. I thi...

2008-10-31T16:25:00.000-05:00

wow, if that was satire, it was really bad. I think it probably was not however, just so bad that the only defense was to call it satire after the fact. That doctor is most likely just a really bad human being who got into the profession for the money, ala Frank Burns.

Anonymous 03:06,One of the best ways to determine ...

2008-10-31T16:00:00.000-05:00

Anonymous 03:06,

One of the best ways to determine the quality of satire is the outrage in responses from those with different points of view.

Using that metric, this clearly is high quality satire. The responses resort to obscenity, name calling, and even attempts to point out possible inconsistencies in the satirical piece.

It is satire.

Apparently the liberal commenters, in their need to debase this satire, actually give it very high marks.

I agree. Great satire Dr. Scalpel.

Maybe it's the ER they don't understand then. I po...

2008-10-31T15:17:00.000-05:00

Maybe it's the ER they don't understand then.

I posted this comment at Klein's:

Thanks for the link. To understand my post, you have to understand the Designers Holy Triangle. But since I don't get to set the rates for my services, you really only get to pick one....fast or good. And usually you don't get to choose, I do.

Of course I treat all comers regardless of payment, but the one thing over which I have control in my little Marxist world is the effort I put into each interaction. I can make you the plain Swiss Miss powdered cocoa mixed with hot water or the Ned Flanders special. Either way you still get served, right?

Rogue Medic:It's possible both to understand satir...

2008-10-31T15:06:00.000-05:00

Rogue Medic:

It's possible both to understand satire and recognize very poorly done satire, that in no way conveys what it was seemingly intended to convey.

Swift's writing is satirical, but it's also coherent. This post is satire, sure. It's just exceedingly shitty satire.

I don't think liberals understand satire. But it's...

2008-10-31T14:41:00.000-05:00

I don't think liberals understand satire.

But it's cool that Klein linked here. I was wondering where all those sinister commenters came from.

It is amazing how few people understand satire.Whe...

2008-10-31T14:33:00.000-05:00

It is amazing how few people understand satire.

Where was Dr. Scalpel actually advocating not treating sick people?

Where is Dr. Scalpel making any kind of racist statement?

Bob in Pacifica makes the argument - this is the way the government currently running thing, you live in this country, therefore you are the reason things run this way and you are being a hypocrite for not admitting that it is all your fault. You are a hypocrite for trying to change anything according to this attempt at logic.

Brooksfoe just demonstrates childishness.

Anonymous 12:27 just does not get the satirical analogy.

Adam does not recognize the satire, but presumes that all hospitals are privately owned, or at least that Dr. Scalpel's hospital is. This does not really matter, since both can provide bad care for selfish reasons. The suggestion that government control eliminates selfishness is not at all logical. If it were true, people in government would never make headlines for corruption, government contracts would always come in on time and on budget, care at government hopsitals would be far superior to any private hospital - the only reason to go to a private hospital would be for the amenities.

Anonymous 12:34 is another who does not recognize satire.

This post is an example of satire. Perhaps you might understand satire more if you read Jonathan Swift's A Modest Proposal.

Ezra Klein has the following answer to you at his ...

2008-10-31T12:58:00.000-05:00

Ezra Klein has the following answer to you at his blog:

http://www.prospect.org/csnc/blogs/ezraklein_archive?month=10&year=2008&base_name=department_of_unintended_irony#110495

First of two paragraphs of Klein's post:

The ER is the most Marxist building in the modern American hospital. By law, it treats anyone who decides to bleed in the waiting room, no matter their ability to pay, thus fulfilling the "from each according to his ability" requirement. It parcels out medical attention based on severity of condition rather than thickness of wallet, thus fulfilling the "to each according to his need" requirement. It's a socialists redoubt in a capitalist system.