What Jesus would do, and say, today…

My most recent Greenville News column.

http://www.greenvilleonline.com/story/opinion/contributors/2017/02/10/commentary-some-thoughts-what-jesus-would-do/97743538/

Some thoughts on what Jesus would do today 

(As we all grow more and more divided and arrogant in our views.)
Given the current political climate, a lot of our citizens are reasonably sure they know exactly what Jesus would do if he were here now. I happen to have a few thoughts on that topic myself.
It seems to me that first and foremost he’d disappoint us all by not debating the way we do. He’d actually love the people he was talking with, and want the best for everyone. Screaming matches and endless point-counterpoint were never his thing, or so it appears in the scriptures.
I think that while everyone was trying to convince everyone else about their opinion (and not changing anybody’s mind), he’d be on some street-corner healing sick people. And he’d be doing it in a way that was so dramatic people would think he was a charlatan. ‘There’s no way that paralyzed kid can walk now! It’s just a trick to convince simple-minded, unscientific people!’ That’s what some would say. And Jesus would keep right on healing cancer, HIV, gunshot wounds, schizophrenia and other awful problems.
And those people who were so full of inner pain that they wanted to die, and kept thinking that they had no worth? He’d heal their pain, and cast out demons from them. That’s what the Bible says he did, anyway. He said he was God and he taught about things like demons. People probably wouldn’t like that much; neither atheist skeptics or solid, staid, educated Christians. But the people he healed would love it.
Of course, he’d talk to people at the marches, the rallies, in the halls of legislatures and in the churches. Unlike our milquetoast, pale-faced images of gentle Jesus from Bible story-books, he would sometimes look (and be) angry. Angry about injustice and cruelty, angry about the neglect of the needy. He would also be angry about false teachers and others who robbed men and women of faith in God and left them nothing to comfort them. As before he would be angry at anyone who led others to sin. Occasionally, he would be sarcastic and insulting. He’d have harsh words for lots of pastors and sanctimonious believers. Read the Bible; it’s how he was.
Our many-flavored hatreds would give him plenty of fuel for parables, in order to guide us to the truth. But he would also be unhappy about the division and ideas heaped on people that leave them feeling worthless. Like the idea that humans are a scourge, a virus on earth. Or the obsession with hungry, sick animals while children face the same. And the way men and women are weighed down with one of two burdens, endless victimhood and its chiral image, the belief that some people’s ‘privilege’ causes all the world’s problems. He came to liberate everyone from beliefs that imprisoned them. He condemned religious leaders in his day for giving people burdens but not helping carry them; he would do the same for modern politicians and educators, ministers and mullahs who create anger, tension and violence in order to control and manipulate others.
Obviously, would talk about ‘sin,’ from greed to sexual immorality to idolatry and all the rest. He talked about those things a lot. He’d preach about the coming Kingdom of God and eternal life and redemption and judgment. He was serious about sin, but kind to all sinners, right, left and moderate. Conquering sin and death was his main mission, after all.
That would be just about enough for lots of folks. Because they didn’t come to be pressured about morals or lectured about their personal lives or told stupid fairy tales; they came for justice! For revolution! And they’d ask him to leave. Or maybe scream at him, because it’s what we do when we’re angry and sure we are right.
Ever the gentleman he would leave if asked. But before Jesus left, he might remind all of the passionate, angry people of what he said before:
“You have heard that it was said, ‘love your neighbor and hate your enemy.’ But I tell you, love your enemies and pray for those who persecute you, that you may be children of your Father in heaven. He causes the sun to rise on the evil and the good, and sends rain on the righteous and the unrighteous.’
It seems to me that in his absence he remains present, and his teachings still condemn our hatred 2000 years down the road. If only we’ll listen.

Election Related Illness…

Now that the presidential election is past, national emergency departments are seeing an increase in election-related health problems. While anxiety, depression and homicidal rage are what one might expect, it turns out, according to emergency physician Dr. Chuck McShortridge, the bigger issues seem to stem from people sitting at computers all day long and linking to political posts on Facebook, Twitter, Reddit and assorted other online outlets.
“Just last week we had three patients with massive pulmonary emboli. I asked their spouses about surgery, cancer, fractures, trips overseas, and the common thread was this: ‘No, but he (or she) spent the last six months linking to articles about how Hillary is a crook or Donald is a liar, or something like that.’”
Other physicians have noticed the same. Dr. Maggie McFarris reported another issue: “I keep seeing patients who complain of a constellation of symptoms: blurred vision, sleeplessness, carpal tunnel syndrome and in some cases, acute renal failure. I call it Donald-Clinton Syndrome. They never get off the (expletive deleted) couch. All day long it’s ‘that Hillary is a crook who can’t be trusted’ or ‘he hates women’ and links to dozens of articles a day. They don’t eat, they don’t drink, they don’t exercise, they don’t even have sex.”
One spouse we interviewed in the waiting room of a large ER said, “My wife has lost a lot of weight because she won’t eat! Just the other day I made this great vegetarian dish she loves and all she said was ‘I don’t have time, I just found this incredible piece on Trump at Politico and I have to share it!’ I ate dinner alone. Thank God the election is over say she can finally get the Xanax and IV fluids she needs.”
On a related note, some politically active physicians we met in the course of this article are lobbying to have advocacy counted as CME. Dr. Joseph Mooring, known for his bumper-sticker-laden Subaru, political buttons and frequent presence at online forums, stated: “CME? Who has time for that? I’m trying to save America, and in the process American healthcare! I should totally get credit for the hours I’ve logged trying to save the nation!” American Board of Emergency Medicine representatives said the board might be able to work political advocacy into the new Lifelong education modules.
Practitioners are urged to continue to be diligent in looking for election related illness and injury.

Idols All Around

http://www.greenvilleonline.com/story/opinion/contributors/2016/11/14/commentary-humans-easily-deceived-idols-every-sort/93588762/

One of the consistent themes that runs all through the Bible is the theme of idolatry. And if we can learn anything from its writers down the thousands of years and hundreds of generations since they lived, it’s that humans are easily deceived by idols of every sort.
It’s arrogant for us to laugh off the idea of stone and wooden deities, and shake our heads at the fish or dragons, serpents or elephants that they represented to our ancestors. (That’s right, all of our ancestors!) Because we’re no less susceptible despite our assertions that we are modern and rational. Twenty-first century man remains a remarkably idolatrous creature.
This is rarely as evident as it is during a presidential election cycle, when we believe that vast power, and all our destinies, rest with the office and person we are electing. If only we elect him, or her, all our problems will be solved and our enemies smitten! We elevate candidates and politicians to places they were never meant to be, not by God, nor indeed by the founders of our republic, who doubtless had a much more suspicious view of human character than we do; else they would never have built in so many checks and balances.
In fact, during elections we also make idols of government in general, constitutions, courts and legislative bodies. We worship commentators and media outlets and anyone and everything connected with the process. We idolize our own opinions and spend far more time in our own personal echo-chambers than we do either worshipping God or (for the non-religious) simply pursuing secular knowledge or simple joy. Pity, as our self-adulating tirades and tantrums change few minds.
But it isn’t only politics. We all have our idols. Thanks to social media, young people take constant photos of themselves in a kind of self-worship. Social media have also allowed Americans to make an idol of the approval of others, whether in likes for one’s selfie, or agreement with one’s views. The disapproval of others is a bitter pill whose side effects include exclusion from friendly society; a kind of excommunication for heresy. How many opinions would be shared more honestly if not for the fear of being shunned or attacked en masse online?
Conservatives often idolize guns or military prowess, as if they could save us from all danger. And yet the Bible says ‘Some trust in chariots and some trust in horses, but we trust in the Lord our God.’ (Psalm 20:7) (The chariot being the main battle tank of antiquity, by the way.) And liberals make an idol of choice, as if replacing the word ‘killing’ with a euphemism makes it less like the reality of killing an unborn child, less like a modern adoration of the dark god Molech.
We idolize the freedom of sexual expression and sexual orientation, as if all that mattered in this life were who could have sex with whom. And on the other side, we idolize morality, as if our sanctimonious attitudes about sexual sin were anywhere as important as the forgivingness and redemption offered in the Bible to those who sin sexually, gay or straight. Grace matters more than moralism.
America idolizes the idea of compassion and charity without understanding the moral and spiritual underpinnings that make it reasonable and possible. And yet, we also idolize the American concept that everyone can simply succeed if they try, which is simply untrue. The deck is sometimes stacked and there are those who need our assistance, personally and through state programs. Some idolize capitalism, some idolize socialism, but both can become monstrous deities when not applied with Godly wisdom and caution.
The Decalogue begins with ‘I am the Lord your God who brought you out of slavery, out of the land of Egypt.’ And follows it immediately with ‘you shall have no other gods before me.’ And of course, after receiving the Ten Commandments, the people promptly made a Golden Calf and ignored God, the source of all their good things. You can be an atheist and still see the truth in this tale. This is the story of all mankind. The worship of those things we shouldn’t, and the rejection of those things that are truly, ultimately good.
Whether a citizen is religious or not, we can surely agree that we all have idols we should take from their altars. Maybe it’s a good time to start.

I Love America! My latest Greenville News column.

It’s an ugly political season.  But I still love America!  This is my most recent column in the Greenville News.  Please share liberally.

http://www.greenvilleonline.com/story/opinion/contributors/2016/10/23/ed-leap-love-america/92453876/

Over the Summer I was working in the ER at North Greenville Hospital, doing some temporary work for GHS. I arrived in Traveler’s Rest early one morning to get some breakfast and a drink for work.
As I pulled into a drive-thru, I looked at the nearby gas-station. I was amazed at how busy the place was. And I was suddenly overwhelmed with love for America and her people. It was about 6:45 in the morning, but there were cars and trucks of every variety. I saw utility company trucks and pest-control vans. Those pulling trailers full of lawn-equipment, with mowers and weed-eaters. Electricians, plumbers, contractors, police and EMS workers were getting out of all manner of vehicles. Many essential, difficult jobs were represented, as men and women were headed to work. Motivated by dreams of success, and by love for those they support, they were up with the sun. There were people of every race and ethnicity, many of them working on the same crews, for the same companies, laughing together.
It was going to be a long, hot day, so they were loading up on breakfast, coffee, snacks, water and other drinks. Trucks were being fueled, the staff of the gas station hurrying to keep up. There was an energy there that was quintessentially American. I felt honored to see it.
The wonderful thing is that America and Americans, for all our contentious behavior, remain wonderful. We work and innovate. We strive and create. We educate and parent and look after our loved ones young and old. And despite the reality of bias and discrimination, we are one of the most welcoming nations on earth. We adjust to social changes, we generate and rapidly adapt to technology, and even when it looks bizarre, the average citizen and average politician try to make democracy work.
We are conflicted at times, but usually over means, not ends. We want to help refugees even if we reasonably fear terror. We may worry about immigration but typically enjoy immigrants as our friends and neighbors. We desire to see the poor and their children lifted up. We still, as a nation, want to see justice done. Thus we are equally offended by false imprisonment of the poor and by the way the wealthy and connected sometimes stand apart from the law.
I meet all kinds of Americans in my work. I meet poor, rural Southerners struggling to find jobs, and facing chronic diseases with limited resources. I meet immigrant families trying their best to care for sick children. And even though we live in the South (where popular media loves to paint us as just so hateful), I regularly encounter doting white grandmothers and grandfathers cuddling and adoring their beautiful, mixed-race grandchildren, looking after their sons and daughters-in-law who have different skin colors, and sometimes different languages. I am often amazed at the men and women whose English grammar may not be perfect, but who learn Spanish out of love for a partner; not for a grade in a class or semester abroad.
I see my colleagues care for everyone, with never a thought to treating them poorly because they are gay, lesbian or transgender. I watch as physicians and nurses struggle mightily against the death and suffering of people different from them.
There are churches and pastors, congregations and church groups as well as government and secular organizations (and individuals) who help provide housing for the poor and drive people to work who are battling the nightmare of drug addiction. Those same people adopt children and spend time and money to give food to hungry families.
In America the laborer and the academic are both passionately devoted to fairness and those who never graduated high school are as important to the republic as those with advanced degrees.
Are there exceptions? Obviously. And it doesn’t take many hateful, cruel, manipulative people to cause great damage. ‘A little yeast works through the whole batch of dough,’ said St. Paul.
And yet, the lovely reality is that we remain a great nation, going through a hard time. I don’t know where it will lead. Maybe to darker places, maybe not. But for now in America, the America I see every day that I work, the America that starts the day early and ends it late, working together for common cause, the love outweighs the hatred, the strength outweighs the weakness, every time.
That’s something to celebrate.

Let’s Stop Bullying (Attention Adults!)

This is my latest column in the Greenville News.  Bullying is at its worse, but most acceptable, when adults use it to intimidate people who disagree with them.

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http://www.greenvilleonline.com/story/opinion/contributors/2016/10/09/lets-stop-bullying/91666120/

Let’s Stop Bullying

I well remember being bullied on the school bus. Many cold, wet mornings (a large portion of the year in WV, by the way) I found my junior-high self sitting in front of high school juniors and seniors who turned their class rings upside down, then used them to hit lesser life forms on the top of the head in a whipping motion. Turning around in pain and anger, trying to find my assailant, was pointless. ‘What are you looking at?’ they asked. It was a very long ride to school.
To this day, kids are still assaulted and treated badly by other kids. Children and adolescents are called cruel names and belittled by those who have more things or more opportunities. They’re told that if only they’ll wear these clothes, or listen to that music, engage in some sexual act or take that drug, they’ll be accepted. Bullying comes in many forms, it seems. And now we have the added joy of the Internet. No small number of young people have been mortified, emotionally traumatized, considered suicide or actually committed it in response to online slurs and cruelty, or embarrassing photos or video posted online.
These days, adults are supposed to understand, and teach their kids, that no one should be mistreated, harassed, harangued, belittled or besmirched in our hallowed school hallways for any reason at all. But something happens after we leave school. Suddenly, adults believe that bullying is OK as long as it’s about something that’s really, really important, and as long as the people they bully are different from themselves. It seems that in actuality, adults are the worst bullies around.
These days, in order to find bullying one need look no further than any discussion about politics (or frankly, culture, religion, science or almost anything else). I’m simply stunned at the way purported grown-ups with differing opinions can treat one another. Online forums and media comment sections drip with disdain. Those who believe ‘the wrong way’ are instantly labeled ignorant, or irrelevant, and often called names. Sometimes, people even wish death upon others.
In fact, that’s one of the clearest forms of adult bullying I see. ‘Well, if you weren’t so ignorant, you’d understand the truth.’ Even those with no particular knowledge of a topic consider those who disagree to be stupid, plain and simple; it’s a strange kind of ‘pseudo-intellectualism,’ in which the enlightened get to wear the mantle of truth. A truth largely determined by the crowd; not surprising in an era when truth is considered a personal choice like food on a buffet.
This sort of argument is everywhere. And not just in the Wild West of the Internet. Even noted political figures accuse their detractors, saying that they’re uneducated and backward or they’d see the truth.
Adults love to bully, no matter how much they pretend to hate the idea. We see it in its soft form in the recent video of celebrities reminding everyone else not only to vote, but who to vote for. They’re the cool kids. They may not be the smartest but they’re the richest and best; they’re sexy and sarcastic. Don’t you want to be like them? Remember, beautiful, rich, famous people are much better (and insightful) than regular poor people!
Comedians once entertained us with the universal, self-deprecating, slap-stick humor of everyday life. Now they, too, are the cool kids yelling their invective at everyone who dares to have an opinion off the mainstream. Biting and cruel towards those they don’t understand, they represent little more than a shinier, richer form of the old-school bully.
Bullies use words to great effect. Disagree with a candidate? You must be a racist, or a sexist. Disagree with a law? You must be a bigot or a fascist. Believe your God is real? You must be a fundamentalist nut! You don’t want to be a bigot or fascist or a nut, do you? Then just do like everyone else does and you’ll be so cool! There, now doesn’t it feel better to be like the crowd? (Now remember kids, you should always be yourself and follow your own heart. Until it takes you outside the bleating herd, that is.)
Robust dialogue is good for a nation. As in evolution, ideas diverge and produce more good ideas. The future of our freedom demands that we disagree. But bullying is the stuff of brutish children.
So let’s stop it, shall we?

The Presidency Won’t Change the Division

The first presidential debate is over, and all I can say is that these are interesting times.

The fact remains that whichever candidate wins the presidency, the nation’s polarity will not be suddenly reversed. We are spinning further and further from one another all the time, divided by many issues, by race, gender, religion, accusation and insult. Are we one nation anymore? Hardly. We’re many nations trying to control all the others.

The election itself cannot change that. Whether Donald Trump or Hillary Clinton wins, they are unlikely to do so by a wide margin. And they will make policies that nearly half of the country will find objectionable. Maybe both parties need to strive to bring unity more passionately than they strive for electoral, legal and legislative victory.

 

Are Our Candidates ‘Christian’ Enough? Theology And Politics.

Should our Christianity influence our politics?  Apparently only in some situations.  This is my column in today’s Greenville News.  Not trying to push for one or the other candidate, so I’m not crazy about the title applied to it.

http://www.greenvilleonline.com/story/opinion/contributors/2016/08/14/ed-leap-but-seriously-would-jesus-vote-trump/88514404/

I’ve seen a lot of commentary lately that says Christians shouldn’t vote for Donald Trump. They tell us that he does not, in any way, behave like a Christian. Some of these observations actually come from Christians and are not without merit. But the majority I have seen have been directed from more secular individuals towards Christians.
Instead of WWJD (What Would Jesus Do), the question asked of the faithful seems to be WJVT: ‘Would Jesus Vote Trump?’ And it’s a good question, asked for a bad reason. What bad reason? Manipulation of believers for political ends.
It’s a weird election. I think most of us would like to press the reset button and start all over. But it’s August and these two are the main players in the farce which will raise the curtain on its last act in November. I understand both sides of the argument. In a country sharply divided, Trump and Hillary seem (on the surface) remarkably different. Whether they actually are, we won’t know until later. We’ll have to ‘elect one and see what’s in them,’ to borrow from Rep. Nancy Pelosi.
But I’m troubled by something. The same people who told Christians to take our religion and keep it out of politics (and largely out of public life in general) are now berating Christians who support The Donald because they aren’t properly employing their faith in the realm of politics.

Apparently, Christianity properly applied should be used as a screening tool to decide if a candidate is acceptable based on how closely he or she conforms to the popular notion of ‘Christian’ behavior.
I’m trying to imagine the outcry if, when appointing a Supreme Court Justice, a president opined, ‘I’m really not sure she’s Christian enough for the court.’ There would be no end of shocked citizens, deeply angered by a political decision based on Christianity.
I remember, not very long ago, when Christians applied scripture to the same-sex marriage debate. We were reminded in no uncertain terms that our beliefs had no place in the decision. Ditto for abortion. Christianity, it seems, has no place in policies regarding killing the unborn, and certainly shouldn’t play into decisions about whether or not to provide potentially abortifacient drugs! Take that, Little Sisters of the Poor! Silly Christians, keep your ideas and nutty beliefs to yourselves. This isn’t the year 1000, after all!
That is, unless we’re talking about the current presidential election, which is odd. For the most part, past candidates who were very Christian were also considered very unacceptable in the eyes of the media and the secular world. Candidates, for example, like Mike Huckabee, the Southern Baptist Preacher or Sen. Rick Santorum, the devout Catholic were far too ‘Christian’ to be considered for the presidency. Even Gov. Mitt Romney, Mormon, was just too ‘Mormon’ despite being a very nice, loving husband and father. Good grief, he was the Republican ‘anti-Trump!’
So by now many Christians have learned their lessons. In a grim political and cultural milieu, they have decided that maybe the loud fellow with the bad attitude, who says what many people are thinking, might just be ‘the guy.’ Besides, I don’t really think that Christians voting for Trump are under the delusion that he is representative of Christianity. They just think he might do things that are a little more in line with their beliefs, a little less likely to threaten their values. He might be ‘a little less bad.’ They know they may be wrong, that it’s a gamble. But those of us believers who know our history also realize that our brethren down the ages have been led by far worse (and far less ‘Christian’ ) leaders than either of the current candidates for Commander in Chief. And some of them were quite good for Christians in the end.
I’m not trying to convince anyone to vote for any candidate. Please, vote your conscience. But we should all try to have charity towards those on the other side, who support candidates for reasons probably more nuanced than we believe. (It’s much easier to call our enemies stupid than attribute any intelligent motives to their behaviors.)
And while I believe those who want religion to stay out of politics are ultimately unrealistic, they should at least be consistent. It’s terribly unfair to tell Christians to leave their faith outside the ballot box, but then condemn them for actually doing so.

Fighting drug abuse in the ER

Fighting Drug Abuse

My latest column in the Greenville News.

http://www.greenvilleonline.com/story/opinion/contributors/2016/04/09/commentary-fighting-drug-abuse-er/82713082/

I have a lot of ER stories that involve drug addiction and drug seeking behavior. I knew a patient who intentionally dislocated his shoulder three times in one day to receive pain medication. Another had a friend who stole an entire dirty needle box in order to rummage through it for injectable drugs.
I have been told by patients that pain pills were eaten by dogs, stolen by neighbors, lost in car crashes, accidentally flushed down toilets and all the rest. People have pled with me because their normal doctor was out of the country. One individual (call him Bob) came to me and was denied narcotics, then returned two hours later with a woman’s ID and saying he was she (call her Carol). ‘You aren’t Carol, I just saw you.’ ‘Yes I am, I’m Carol and I’m in pain.’ ‘Get out,’ says I. The list goes on and on and every physician has a few of his or her favorites.
In the annals of American medicine, it turns out this was all rather new territory, at least in scope. My career began in the early 90s when there were (for various reasons, corporate and otherwise) powerful initiatives encouraging us to treat pain with more narcotics pain medications like Lortab, Vicodin, Percocet and others. We were regularly scolded for being cruel and insensitive about people’s pain when we, young and innocent as we were, expressed discomfort with this practice. I remember being explicitly told, more than once, ‘you can’t create an addict in the ER.’
We were told that pain was the ‘fifth vital sign’ and were taught to use a ‘pain scale,’ which you’ll hear to this day whenever you interact with the healthcare system. ‘What’s your pain on a scale of zero to ten with zero being no pain and ten the worst pain of your life.’ Most nurses can say this in their sleep. We developed smiley face scales for small children to use.
We learned to give narcotics regularly for various types of pain, when they had been previously reserved for cancer, long bone fractures or significant surgeries. Medical boards were encouraged to discipline doctors who were reported to under-treat pain. And hospital administrators, ever in love with the ‘customer satisfaction’ model, pressured physicians whose patients complained about receiving inadequate pain treatment. (High patient satisfaction scores have been studied and associated with poor outcomes, by the way.)
Although it’s difficult to quantify because physicians feared for their jobs, I’ve spoken to many physicians over the course of my medical and writing career who were told by their employers to give narcotics when requested or risk loss of income or of employment.
This happened even in the face of staff who knew the abusers. We used to keep files so that even new physicians could tell who the problem patients were. Eventually, we were told to stop. It was a kind of profiling and it was unacceptable. Always assume they’re telling the truth, we were told.
Sew the wind, reap the whirlwind. Since 1999 prescription narcotic overdoses soared, quadrupling over the period to 2014 according to the CDC. Over that period there were 165,000 deaths from prescription opioids, most commonly Hydrocodone, Oxycodone and Methadone. In 2014, over 14,000 people died from those drugs.
Now, the move is from condemning our insensitivity to questioning our judgement. Prescription drug abuse is a high priority for state and federal law enforcement, state medical boards, the Drug Enforcement Agency and The Centers for Disease Control (which recently released new, more conservative guidelines for chronic pain treatment).
States are using online prescription monitoring programs and many hospitals are putting policies in place to give as few narcotics as possible in emergency departments. It’s a Catch-22 of course, as some patients with legitimate pain are told to find pain specialists or family doctors, when they either have no money to do so, or have no physicians in the area taking patients. Thus, they circle back to the ER where we try our best to remain both diligent and sympathetic.
Physicians and hospitals are now engaged in a constant battle to combat drug abuse, to save lives and help empower the families of those struggling with addiction, who are desperate to help their sons, daughters, husbands and wives.
I hope we maintain our compassion. But I also hope that it keeps getting harder to walk into an office or ER and get addictive, lethal prescriptions.
Because it’s time for this nightmare to stop.

 

 

If this is an emergency, hang up and dial 911…

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Currently, in American healthcare, experts are wringing their hands in confusion.  I mean, people have insurance, right?  And yet, healthcare is still expensive and dang it, people just keep going to the ER.  Visits are climbing everywhere and I can speak from personal experience when I say that we’re tasked with more and more complex and multi-varied duties in the emergency departments of the 21st century.

I’m not a medical economist.  I do have some thoughts on the well-intentioned but deeply flawed Affordable Care Act. However, I won’t go there right now.  What I do want to address is the ‘go directly to the ER’ mentality of modern American medicine.

Call your physician.  If it’s after hours, the recording for any physician or practice of any sort in America will have a message:  ‘If this is an emergency, hang up and dial 911.’  It’s a nice idea.  But of course, it presumes that everyone really understands the idea of emergency.  In fact, they don’t.  We understand that, or we try to, but we see lots of things that come in ambulances, or just come to the ER, that really aren’t.

‘I feel fine, but my blood pressure is up.’

‘I was bitten by a spider and I watch nature shows and I know how dangerous they are.’

‘I have a bad cold and I have taken two rounds of antibiotics.  I have an appointment with my doctor tomorrow but I thought I’d just come on in to get checked out.’

The list goes on.  In part, it’s because we do a poor job of educating people about their bodies and their illnesses.  Online searches usually result in someone self-diagnosing Ebola or cancer, so that doesn’t help much.

But in part, it’s because the ER, the ED, has become the default.  Surgical patients are told to have wound rechecks in the emergency department.  Kids with fevers are directed there by pediatricians or family doctors or secretaries.  People who need to be admitted are sent in ‘just to get checked before they go upstairs.’  Or sometimes, so the physician on duty can do the negotiation with the hospitalist, rather than having the primary care physician do so.

Why is the ED the default? In 1986 Reagan championed and Congress passed EMTALA, the Emergency Medical Treatment and Active Labor Act, which says you can’t turn anyone away for reasons of non-payment.  Another well intentioned bit of government meddling, it never provided any funds for it’s expansive act of compassion so many emergency departments and trauma centers simply shut their doors.  You can’t see patients for free all day and still meet your budget.  I think something needed to be done, but it probably went too far.

Fast forward.  Insurance is expensive even when the government mandates it. Whether for fear of litigation or due to over-booked schedules everyone else can always send patients to the ED day or night for any reason.  We still function under EMTALA and that will never, ever change.  Patients have little to no expectation of payment when covered by Medicaid and know it (and thus use the ED for everything, and I mean everything.  We are seeing expanding life-spans for the elderly, but with more complex illnesses being treated and ‘survived.’   We have fewer and fewer primary care providers.

Who actually thought emergency department visits would decrease, and why?  Did they ask anyone who saw patients on a daily basis? Or only lobbyists, administrators and progressive academics with starry-eyed fantasies?

I want to take care of everyone. But the Titanic that is emergency medicine in America is sinking.  We really, honestly can’t bear the burden for all of the chaos of our national healthcare.  And don’t tell me that if we have a single payer system it will change everything, because it won’t.  EMTALA will go on and doctors paid by the feds will not be more productive than they are now, so everything will still flow to the emergency departments and trauma centers of the land.

This isn’t about rejecting the poor, or even criticizing Obamacare.  It isn’t about single payer or Medicare for all. It’s about entrenched behaviors and facing the reality of the system we’ve created which allows one part of the system to attempt to carry the limitations of the rest.

Herb Stein, father of Ben Stein, famously said:  ‘If a thing can’t go on forever, it won’t go on forever.’

And if its’ true anywhere, it’s true in the emergency departments of this great land of ours.

Where the answer to every crisis is: ‘hang up and dial 911.’

We should value each other more than politics

http://www.greenvilleonline.com/story/opinion/contributors/2016/02/26/value-each-other-more-than-politics/80922306/

Allow me to spin tangentially off of politics for a bit, if you don’t mind. (I promise to bring it back around.) After all, I suspect even the most passionate political advocate would welcome some news coverage of an alien invasion or a cat that speaks French, or anything just to take our minds off of the endless drone of political conversation. I feel like Bill Murray’s character, Phil Connors, in the classic movie, Groundhog Day. ‘There’s no way… this winter (or election)…is ever going to end.’
Instead, I want to talk about perspective. Many readers and friends will recall that five short years ago my wife Jan had a metastatic throat cancer. She endured some pretty miserable radiation and chemotherapy. After that she had a large pulmonary embolus (blood clot in the lung) which put her into intensive care and scared us all.
Over time she recuperated fully and our family went back to life as before, but with some incredible perspectives on the value of life, love, health and the inevitable passage of time. She recently had her last oncology visit and was released. Like a cat tip-toeing on wet grass, the years crept up on us and the thing we hoped and prayed for arrived at last, with less fanfare and perhaps more joy than ever. This year we celebrate her 13th birthday, on February 29th, seeing her as the treasure she is.
The great insight here is that all of our battles, won or lost, illustrate an often neglected fact. Which is that however much we may care about elections or economies or all the rest, the real joy and pain of life circles around that person, or those persons, we love the very most. And anything that makes life better for them, or us, probably won’t come from any elected official of any party but will mostly be the fruit of individual effort (and insight) motivated by intimacy and love.
Indeed, those who govern us have their effects, but hour to hour, day to day, year to year, they remain (quite expectedly) unfamiliar with the unique issues of the many and varied lives of their citizens. We, who love one another year to year, hour to hour, day to day, are best suited to improve the lives of our friends and family members, simply by holding them close in life’s assaults.
Happily, this election too, shall pass. Winners and losers will rise and fall, switch places and mostly end up as impotent to steer the ship of state as all those before them. Scandals will strike, accusations fly, a few good things will result and standard political doldrums will likely set in as always. The political pendulum will pause and swing back and forth as it has for ages, with utter disregard for our messianic political prophecies.
The future will come however we fret about the present. In the end, we will (hopefully) leave behind all of our invective, our screaming, our memes, rallies, slogans and our absolute conviction that a particular candidate will end or miraculously transform life as we know it. We’ll simply move on, as all humans do, to new idols. We’ll then cast the current objects of veneration on the dust-bin of history.
Perhaps, if we are attentive, we’ll then see that the things we dread about the future rarely come to pass at all and suddenly, five years, or ten, will pass and we will still be here, expecting the worst. All the while, of course, living in what is possibly the best time to be human in the history of the world. Many of the things that seemed so immediately critical will probably fade and many of the things that really mattered will remain despite the way we ignored their value. Then we can move forward…till the next election!
Ah, but those we love! Their troubles and victories will remain. Our shared joys and struggles will go on, bonding us together as no election ever could, motivating us far more than any party. They are the arena, they are the causes and campaigns where we make the most difference. They the ‘candidates’ who need and deserve our endless, unwavering devotion and sacrifice.
In our deep need to follow, let’s never forget to follow most closely the ones entrusted to us in the daily trials and wonders of ordinary life.