Communications

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Hello again everyone reading my thoughts… Did you know believing people can read your thoughts is a symptom of Schizophrenia? While I may be crazy, I am just not that crazy yet…

An issue that has come up recently and has garnered considerable attention in the media, is a lack of effective communication. In the US we watch one group of protesters complain about police brutality and use of force and another group rally to the cause of law enforcement officials. There is an awful lot of yelling on both sides, but nobody is listening on either side. Given the hyperpolarized state of the US population, it is not surprising, but it is disturbing. But this phenomenon is not just limited to law enforcement.

If you are reading my blog here, I am sure at some point in your life you were educated that communication requires the encoding and decoding of information being transmitted by various medium. If you were not so educated, I have remedied that and just pretend like you heard it before.

Prior to Sept. 11, 2001, I recall civil servants, particularly firemen being considered a burden on the hard working taxpaying society. The public perception was that firemen (and women, though they were relatively few) just sat around the station, sometimes playing a game like basketball or ping pong, and eating a feast that amounts to thanksgiving dinner at least once, and often twice a day. (I’ll let you in on a little secret…Sometimes we would make breakfast at the fire department and that feast would be extended to 3 times a day.) In the smaller departments, we didn’t spend much of the day training or even answering calls. I remember going weeks without a call and training was an hour a day, with an extra couple of hours once a week. Some of it was worth-while; at least ½ of it was a waste of time. But when the time came and somebody called, they could depend on the fire department to show up and usually do an outstanding job. There was a constant discussion at all levels on managing our public image, as well as demonstrating our value to the community. One of our most important mantras became “try before you pry,” which was a simple phrase to remind ourselves not to overact and cause unnecessary damage. The mission of the fire service is to protect life, limb, and property. Overzealously causing  unnecessary collateral damage  goes against the very mission. It also pisses off the public who decides if they support our budget and endeavors. A master chief in the US Navy I met once said “Be careful of the toes you step on today, they may be connected to the ass you have to kiss tomorrow.” While nobody at the fire department ever said it, especially so eloquently, it was the unspoken rule. Do not piss off the public. Then that whole Sept. 11th thing happened, and everything changed…Public safety persons in all areas, police, fire, and EMS were instantly elevated to the status of “hero” no matter who they were or where they were found. At first this seemed like long overdue recognition and support, but it quickly became a curse. As newer generations took up the banner, they were not around for the days of struggle. They started at the peak of public support and admiration. A few years earlier, they were the ones trumpeting support. They entered into public service expecting no less than they had given. Of course, when you start at the top, the only place you have to go is down. What we are witnessing now is simply the decline.

The days of the almost drunken hero worship of public safety began to wear off. The public started making demands again, but these public servants were not listening. If they were listening they were not getting the message. A critical failure of the encode-decode communication mechanism. The falsely believed “special class” or “special status” of public safety and the newly coined term of “first responders” (the idea that canaries were first responders was obviously lost) did not permit a return to the attitude of public service. They now felt “entitled.” That is a rather evil word as of late. They believed they were entitled to unquestionable public support. They believed (and still do) they were entitled to safety even at the expense of the public they served. This manifests in many ways, from militarization of the police, to reneging on the fire service mission statement of the protection of property, to the EMS services demanding they are only for “real” emergencies as defined by an adrenaline fix to the provider, and even into the hospital emergency rooms. With recent wars in Afghanistan and Iraq, even the military got involved and transformed from citizen soldiers, to a protected and special class. For all intents and purposes, the US is devolving into a caste system. Politicians and Business leaders at the top, followed by the military, coming in at third “first responders”, and at a distant fourth, the mere peasants (or civilians as they are sometimes called) and rounding out the bottom, the undesirables (untouchables.) What separates a civilian from an undesirable? Mostly socioeconomic status with a bit of racial divide thrown in for good measure.

It would be extremely ignorant for us to believe that most of the upper echelons are not white people. Most of them have either been born into their respective classes or have worked their way into them by their own hard work and tireless efforts. But the thing that all of these people have in common is a set of values, a culture; which is defined in anthropology as belonging to a group for the sharing of resources and reproductive rights. We live in a world where there is simply not enough to go around. There is not enough for the population of the world, there is not enough for the population of the US or any other country. There is not enough for the cities or for any individuals. Just as you can move up in the social pyramid, you can also go down. But the true tragedy of it is that as time goes on, the ideals and morals of the protected classes become more absolute. The US legislates and vehemently enforces the separation of these classes. Don’t believe me? Look at the local ordinances prohibiting the charity feeding of the homeless because it creates “a nuisance.” Having poor people in the community is now considered a nuisance. Think about that for a minute in a French Revolution sort of way. There are “news” channels which spout the propaganda that anyone not in the white middle class are unworthy, undeserving, lazy, and a general drain on the resources of society. That is right in line with the level of propaganda seen in Russia or China. It is the vilification of an entire group of people. It dehumanizes them. Once they are dehumanized, they are the enemy, and all manner of ill treatment can be justified. Some say eluding to use of Nazism automatically discredits an argument, so rather than talk about Jews, gays, and political rivals of Nazi Germany, let’s look at some more modern examples shall we? In Iraq, there is a Shiite Muslim majority. Who vilifies and dehumanizes the Sunni minority. They have all but cut them out of the governing of the country. In the Islamic State, Christians and the conquered can be beheaded or sold into sexual slavery. As they are not of the ruling culture, they are subhuman. Property to be disposed of. A history shared by the United States in fact, but often considered historical and not relevant today. Do you really believe that dehumanizing people to the point of simply possessions or resources is not relevant today? Consider predatory lending practices. That assumes people are resources to be exploited. Forget predatory lending, look at how mortgage bankers talk, particularly about foreclosure. Then remember for a minute the constant propaganda of the unworthy, the lazy poor, the entitled attitude of the poor, on TV, on the internet, in casual conversation.

Consider for a moment, legislation designed to protect the special classes in the US, exemptions of the politically connected or powerful. As I type this, the United Nations with support from the USA, is pushing for charges of crimes against humanity for North Korean officials. That is rather rich from a country that detains prisoners without due process or trial. That plays with words to excuse itself of treating them like enemy soldiers in war. That tortures people under the guise of keeping it’s people safe. That spies on its citizens under the guise of security. The protected elites of Stalin’s Russia needed security too you know? Then go on to the military class, laws of “stolen valor” makes it a criminal offense to appear as part of the protected special class. To receive discounts or resources allocated to them. That is not citizen soldiers, that is a caste akin to Pakistan’s military. There are even special courts being set up with different rules and laws for returning veterans than for any other American citizen! Then we move to first responders. The police are all but immune from the collateral damage their paramilitary actions cause. Whether it is throwing grenades into baby cribs or kicking down the wrong door and killing somebody, sovereign immunity absolutely absolves them from accountability. Other laws make them immune from civil responsibility. If the Police kick in your door, shoot your dog, maybe even your family member at the wrong house, not only will they not face charges, you will have to foot the bill for the door repair and even the funeral. Right before you may be cast out of the civilian class and into the untouchables from economic loss. If of course you were not untouchable already. I gave an example of the police, but similar extends to the fire department or EMS. I haven’t heard about criminal charges for some Arizona firefighters who beat the shit out of a seizure patient. I did see a statement from their chief it is the policy of the department to use any force they deem necessary to protect themselves and the public. While I certainly think violence against providers both public safety and healthcare is unacceptable, I also don’t believe they should have free reign to beat people or even kill them. (I am sure most sane people would agree)

So what does all of this have to do with communication? Simple. Nobody is listening. There are citizens (you know citizens supposedly equal to every other one no matter what their job)protesting that they find this cast system and lack of accountability unacceptable. Rather than addressing their grievances, their opposition in public safety are vilifying them, claiming entitled status, and declaring that citizens either support their position or are the heartless enemy of law, justice, and moral society. That is not communication. That is a massacre waiting to happen. It has happened. It will continue until there is real dialogue and progress. Perhaps you may have forgotten about an Arizona representative who was shot in the head because of politicians radicalizing their constituencies? Sure they came on tv and admonished this “disturbed” radical. But they continue the very behavior that led to it. This week 2 NYPD officers are being buried because they were killed by a “disturbed” radical after self-styled “community leaders” rallied them to a frenzy. As of this moment, both of these murderers are on the fringes of society. But how long will it be before they are no longer the fringe?

Healthcare providers like doctors and nurses are also seeing an increase in violence against them. For ages immortal, they have been a protected class. How did they come to lose this protected, even revered status? I would speculate, healthcare providers, such as doctors and nurses, at one time brought aid and comfort to any who sought it. Go to your local emergency room and listen to the providers talk about how unworthy various patients are. How they don’t want to deal with them. How they are undesirable, lazy, abusing the system, and all manner of insult. Look at the primary care providers who will not even see a patient who cannot pay or will make them wait weeks even months. Look at hospitals who will refer destitute people to collection agencies, taking anything they can get regardless of the price paid by the debtor. In medicine not a day goes by that I do not hear at least 50% of doctors I interact with claim they do not get paid enough. That is strange to me considering doctors are among top earners in every society in the world. Not a day goes by I do not see doctors dismiss the concerns, questions, or pleas of patients. Including examples where doctors cut into patients with a scalpel without anesthesia of any kind and ignored the screams and cries of the patient to stop while telling her it doesn’t hurt that bad. Healthcare providers maybe hearing the demands of their patients, but not really decoding what they are really trying to ask for. This hubris, focus on wealth, and dehumanizing of patients is costing the reverence and neutrality of patients and the public. It is creating a class system of an “us” and a “them.”

You should see what providers from EMS to doctors are posting on the internet, from satire websites, to Facebook, to blogs. Sure, we have stress. Sure we need to unwind and dark humor is a very effective way. (For me it is perhaps the best way) but it really makes us look like assholes on the internet. When somebody gets punched, bitten, or kicked, maybe we shouldn’t act so surprised?

In the immediate time, this polarization must stop! It cannot be “us vs. them.” it cannot be “you support us or you are against us!” We must make every effort to break down the movement towards a caste system and once more be neighbors and community members. We must once more respect that there are people with different values and needs, and rather than criminalizing them, find the common ground. We must be servants of the people, not their masters or moral dictates. There must be a balance between liberty and security. No matter what we value or believe, we need to start agreeing to disagree sometimes, not make one point of view against the law. We must strive towards all lives matter, not some lives matter more because… Whether you are a police officer, a firefighter, an EMS provider, a doctor, a nurse, or whatever, we need to sit down, talk to our communities, understand what they are saying, and change ourselves. I will leave you this year with a quote the origin is lost on me, but I didn’t make it up, and it has had a profound impact on my life.

“To whom much is given, much is expected.”

I didn’t get my blood money…

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Hello again everyone, welcome to the second blog post in a week. I am going to come right out and warn you this is going to be a long one.

This week I was engaged in no less than 3 online debates on the value of homeopathy, the link between vaccines and autism, and the conspiracy of big pharmaceutical manufacturers and doctors. (real doctors, not the naturalists, homeopaths, etc. masquerading as doctors.)

The long and short of it is I have been accused of being an unintelligent sucker who has either been fundamentally and greatly deceived into “believing in science” or I am a co-conspirator. I actually find this very offensive because I am actually rather intelligent and I take great pains not to use my intellect to take advantage of people. I also give rather freely my knowledge (which came at great cost to me) and time in the effort to help people.

So, without further adieu, I will state: Naturopathy, homeopathy, and the idea vaccines cause autism is utterly bullshit; 100% unequivocal, without controversy or doubt. Anyone who tells you otherwise is lying to you or taking advantage of your gullibility.

The reasons people actually seek out and pay these charlatans all comes down to 2 things. 1. The need for reassuring explanation for things they don’t understand 2. Desperation.

Creationists use the argument that “nobody really knows how the universe is created” and that in the absence of evidence to the contrary, their position is reasonable. After all, logically if there is no evidence, then everyone who studies evolution could be wrong. They go on to subscribe the idea there is a controversy and as such, people should be taught and accept it as fact.

This is the exact same technique of homeopaths, vaccine deniers, naturopaths, etc. (henceforth referred to here as charlatans.) They use what is known as “pseudoscience.” Briefly described, the scientific method is a system. By presenting their case in the form of science by manipulation, they attempt to give an air of credibility. Like all con artists, they are very believable. You can almost hear people say “they seem like such nice people who care…” The exact same thing you hear from the victims of economic con artists. In fact, their active communication skills are top notch. They will listen to you for hours, repeat what you have said to show they are listening; they will empathize with you, and even support your concerns or delusions.
Some of them even buy their own bullshit, which is sort of like a drug dealer who abuses the drug they sell. I have argued with them at length, even before this week. Like any psychopath, they cannot be convinced or even acknowledge they might not have the actual answers they think they do. The only people I have come across who can be more manipulative are psychiatric patients.

It might be because they are basically psychopaths who are tricking people into supporting their delusions. They prey on the vulnerable, those without education in medicine. Those who are afraid from numerous things such as terminal diseases, to the vastness of knowledge of the modern era, to the depressed, hypochondriacs, and even those just not happy with themselves.

The whole of homeopathy is based with the idea that “like cures like.” This is based largely on 18th century symptomatology. They profess that an excessively diluted poison, will cure the poison (disease) that is causing your ills. Which at some level does sound almost like vaccination science. If I give you “a little” it can cure you of a lot. By this theory, if you have say…HIV, by giving you a smaller dose of HIV, you will get better; the same with all the other “diseases.” So by that logic it is like suggesting the way to cure your atherosclerosis is by diluting a Big Mac in water, until there is no molecular trace of Big Mac Left, and then selling this “tonic” for you to drink. When confronted with the absurdity of this argument, they double down on the idea that water has “memory.” One of their best arguments is “nobody knows the true shape of water.” Except that we do. You see we know life on Earth exists because of water. It has many unique properties other molecules do not. It bonds at an off-set angel. It constantly donates and absorbs it’s hydrogen atoms, and a few others I am too tired to look up and verify. The idea of water having “memory” would mean that it is not in this state of constant flux. I should probably point out great minds, other than my own, have figured out that the holy grail of homeopathic remedy is basically an atom diluted in a volume equal to our entire solar system. Nothing like a curative bottle of water priced like medicine. At least the snake oil salesman of old had the courtesy to mix together a foul flavored concoction to make you think it was beneficial. (Because we all know medicine tastes bad right?) You must understand, if they actually had an “active ingredient” in their prescriptions, they would be regulated like other medicines, including the need for rigorous scientific review of efficacy. They also very cleverly skirt the legal aspects of practicing medicine. You see like a very underhanded lawyer, they will not diagnose or prescribe to you, they will give you an elaborate explanation of what “might” help and the means of presentation leads you to “your own” conclusion that it is beneficial. Of course the story is so heavily weighted, you would consider yourself a fool if you didn’t reach the answer they dangle in front of you.

Which brings me to “naturopaths”, those who claim that man-made medicines are not as beneficial as naturally occurring ones. Unlike homeopaths, I am not sure these charlatans actually believe their bullshit. However, they will be happy to sell you some. According to them, we should not be deceived that  the primary purposes behind formulated medications are things like reducing side effects, having a uniformly measured dose, are free from contamination, and actually get to the part of the body they need to go to. One of their favorite prescriptions are things containing “vitamins.” You see, vitamins are really safe bet. You will urinate out any excess of water soluble vitamin harmlessly, and you need a prescription from a real doctor to get an active fat soluble one (because you can overdose and die on those). Which of course would make them responsible.

Without the benefit of lab test like modern medicine, they have no quantitative evidence you are deficient. You may even have too much. It is convenient really. With nothing more than your story, they can analyze every part of your physiology and its complex interactions. It’s almost like having X-ray eyes that can act as a diagnostic lab too. It would be nice to be able to do that I must confess. But similar to homeopaths, in the end, they are offering you basically nothing. You see, all doctors actually understand “natural” remedies. At least they should. But I doubt you will get a prescription for opium extract, potassium cyanide, magnesium sulfate, or other natural medication. Though in some states you might be suggested to obtain some THC. Would you trust a doctor who told you the solution to your problem was opium, but because of restrictive laws you would have to break the law on your own to obtain some? Especially when they could write you a script for several legal versions? Of course “natural” medications like this will help your symptoms. It may even give the illusion of a cure. Let’s face it, if you are drunk or stoned, you will not feel the effects of whatever disease drove you to it.

Both homeopaths and naturopaths are rather fond of cancer as a disease simply because they can’t lose “treating” it. It has been reported in medical journals and texts for ages that those suffering from cancer feel betrayed by their own body. Considering that it is actually a defect of your organism trying to grow as its own similarly to a parasite, it is easy to see where this psychological effect comes from. It may even give rise to psychosomatic effects. Medical treatments for cancer can best be described as barbaric. Unfortunately, until actual gene therapy can be effected, barbaric is the best we have. What are these treatments? I would describe it as such: The purpose of cancer treatment is to kill the cancer cells. Of course these cells are still part of a person. They may or may not be in the form of a solid tumor. So medicine assembles the brightest minds and most determined souls in order to create the perfect way to harm people. From man’s most deadly poisons we call chemotherapy, to radiation, and even surgery (physically cutting you with a blade) the goal of cancer treatments are not to heal. They are to kill. Recently we have discovered that hormonal therapy can also be effective. But like all hormonal therapy, the side effects will be considerable. There are 2 goals of treatment, curative or palliative. While curative may be tried, it may not work. In some cases, it may not even be possible. In the practical sense, “the cure” may be more debilitating than the disease. The question then becomes suffering until a prolonged end, or prolonging the quality of life until a short one. But in the latter choice, some distilled water or natural “chemical” is not necessary to be purchased. Neither are “dietary” supplements or special diets. Though it may give what amounts to a religious icon to distract the person suffering. But a crucifix may be a cheaper one time purchase rather than a recurring bill.

So let’s talk about anti-vaccination

Upfront, we must understand that not all vaccines are 100% effective. Therefore, it is a “best chance” preventative medicine. Prevention in all respects being preferable to attempts at cures, which are very rare in medicine anyway and usually associated with cancer treatment.

Many of the anti-vaccine people I have talked to are obsessed with the delusion of a link between vaccines and autism. A fundamental question of autism is if it is actually more prevalent or just diagnosed more. After all, in the last 2 decades, there have been more advances in medical knowledge and science, than in the entire prior history of medicine combined. Logically diseases we did not know about 21 years ago might be diagnosed and possibly treated today. But as always, before I continue I would like to share with you a story.

My daughter was born in the second semester of my third year of medical school. I was terrified. Not of the idea of having to take care of people. I had been taking care of people at that point for nearly 2 decades. I wasn’t worried about being a poor parent. All parents make mistakes and I simply resolved to do my best; learning from each mistake as I had in other areas of my life. Another experience that served me well is in those same decades, the need for me to make hard decisions based on imperfect information was refined to an art form, and my success in career and life meant mastering that art.

What did scare the crap out me was knowing all the potential things that could go wrong with a pregnancy and human development. From rare congenital defects to in utero development defects, I was being tested on all of them at the time. They were forefront in my mind. I knew any mental defects would likely only show up around the age of 2-3. Shortly after her birth, I took her and my wife to visit a friend of mine who is a pediatrician. Not as our doctor, but as somebody who was a doctor who also had kids and could tell me all the things I couldn’t read in medical books. I confessed to her my fears. She smiled told me that not only had she felt the exact same way, but she was afraid of having any more kids because of no other reason than the fear of what might go wrong. She also asked me about growing up as a boy, because as a lady, she had no first-hand experience of growing up as a boy. Certainly she could have asked her husband, but she trusted I would give her the straight answers.

In medical school I was taught how to diagnose the various genetic and developmental diseases and syndromes. The how’s when’s, etc. I also learned that while we could name them, there was usually no way to “fix” them. That our treatments may simply be giving the best life we can, whether it be reconstructing a heart or hormonal therapy to make Turner’s syndrome kids look like girls.

We were told that the parents would be just as much patients as the children. That they would go through the standard phases of grief. (while the phases are defined as standard, they don’t follow a predictable pattern, and they are not linear, people can go from one to any other and even back a few times) We were told that referring the parents to a specialist geneticist would help them. I spoke with a respected geneticist because I was curious as to what they actually do than other pediatricians can’t. I was told they knew the best way to explain things to the parents. I was also given some knowledge on what exactly those “things” are. One of which was preserving the relationship of the parents when inevitably they turned to blaming the other for defective genes, not eating healthy, or other failings of living the ideal life in pregnancy.

You can see where parents wishing to blame genetic/developmental disorders can find an alternative like vaccines. The symptoms appear around the time of vaccination, like most foods and drugs, there is a label that has some very hard to pronounce, much less understand, words. Some sound down right scary. It helps maintain the relationship of the adults, and focuses blame. Some even go so far as to crusade against perceived personal slights by proxy like the use of the word “retarded.” The anti-vaccine crowd also like to believe they are “saving” others from a similar fate. I suspect at some level this coping mechanism can be therapeutic, but unfortunately, it poses a real danger to others.

Charlatans adapt over time, just like when you constantly beat somebody at a game, they start to identify and take steps against what caused previous defeats. Pseudoscience is the latest adaptation. By creating neutral sounding organizations, rather than biased names like “the anti-vaccination club” and creating professional quality websites, they give the impression of legitimacy. They also create “studies” using the template of the scientific method. To an educated and professional scientist, this fraud is obvious. One of the tricks they use is to state an actual fact unrelated to autism or vaccinations and cite a source which verifies the fact. They then draw a conclusion in no way related, but the visualization of the citation will fool a nonscientist. It looks like legitimate science. A scientist will look up the citation and read what it says. But most uninitiated will not. Even if they do, it is unlikely they will understand what they are reading, IF they actually don’t have to pay for access to the study. (which they most certainly will not likely do)Another of their favorite tricks is to “create” a study, where they comment on quotes out of context on an actual scientific study, liberally cited. But one thing you will not see is data. You will not see it, because there is none. Historically some have falsified data and have been stripped of their medical credentials for fraud. They have even been expelled from the scientific community and with a title that means nothing; they can only pander to gullible for money. They especially like to write their title everywhere for an illusion of credibility. Their final tactic is to hone in on some insignificant detail, like a chemical name. When presented with studies showing no harm or benefit, they begin citing the fake papers they created even more emphatically; dissecting the language of actual scientific studies and not challenging the data. One argument I have heard is an anti-vaccer claim that all of the scientific studies show no acute damage, but there exists the potential for chronic illness. If it were the case that low level exposure to a toxin caused chronic illness, wouldn’t more people be diagnosed with Autism Spectrum disorders later rather than sooner?

When all of these charlatans are exposed, they resort to the only tactics left to those whose argument is completely discredited. They retreat to their group, where the cult leaders who manipulate them and their “peers” reassure their delusions that it is us educated doctors and scientists who cannot see the light; that we are too stupid or too blind. But what really sets me off is being told I am bought off. It makes me particularly angry because not only have I not received a cheque (not to be confused with a check), but because I have spent my teenage years and most of my adult life, including weekends, holidays, and special moments relentlessly learning and refining how to help people, often for little or no remuneration. That is far different from the homeopaths, naturopaths, and anti-vaccers, and nutrition gurus of the world who seem to be sponsored quite well. These charlatans are never around for the death. They never have to answer “why” or deal with the grief related to the deceased. They don’t have to worry about being held criminally or civilly liable for damages for their “advice.” Their misinformation certainly doesn’t cost them their livelihood.

I am not stupid, I am not bought off, and I am not blind to nonexistent conspiracies. Just because another doesn’t understand science, the scientific method, or medicine does not mean that I do not. I am also real good at picking out fakes. I find it strangely amazing there is a federal criminal law against “stolen valor” by those claiming military service, but there is no law, public shaming website, or legal crackdown on those putting lives at risk and sometimes being responsible for deaths. As I said, I am not amazed people fall for this quackery, because it is really easy to take advantage of the vulnerable. Once one is in a cult, it is really difficult to leave the abusive relationship; especially when it feeds ones delusions.

If you have money to waste on essential oils, “natural” supplements , semiprecious gems, and distilled water, why not send a few dollars to a charity that funds research? Why not buy some things for a hospital or school who supports and teaches those with diseases? Why not just take the money and go on the vacation of your life? Why not buy yourself something you always wanted? Something for somebody else? That will make you feel better. If you want to treat autism or cancer, why not go to school and learn how to do it from people who dedicate their lives to it? Go to church if that is your thing. But please. STOP HURTING OTHER PEOPLE TO MAKE YOURSELF FEEL BETTER! If you want to drink snake oil or place blame for genetic and developmental defects beyond your knowledge or control, fine, we have no quarrel. When you start trying to convince others with fraud and lies, I am going to take issue with that.

If you want information on medicine, do not go to charlatans. Go and see the people trusted for thousands of years the world over for the benefit of humanity and individuals. Go to a Medical Doctor. If you don’t get answers, go to another. There is more than one and they are not all the same or equal.

If you don’t want me to tell you how utterly stupid, insignificant, and incapable you are. Don’t do it to me, and certainly don’t accuse me of getting money for taking advantage of people.

Please quit being stupid.

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cheers

One of the things that appear up on my Facebook page quite frequently is a popular blog by/for healthcare providers. Overwhelmingly, the posts on this blog are about how providers hate drug abusers, people “misusing” the emergency department, and how much the author(s) dislike poor people who probably won’t pay their hospital bills.

Yesterday, on a popular EMS website, there was a post stating a documented fact about access to healthcare in a certain ethnic community. (Rather the lack of access) Many providers decided to chime in with insights such as “well if they are illegal they are criminals” and then go on to talk about how they do not deserve healthcare. One offered that they should receive care just until they are deported.

So let me share with you a story? One of the first days I found myself working as a medic in the deep South, I responded to a call for a cardiac arrest at a family reunion. I was told by my preceptor (I was riding 3rd during FTO) that it was important that we got back to the truck as soon as possible. I was not told why. We arrived on scene to find the matriarch of the family dead in a chair. From the rather contorted position of her head, using the old mark-1 eyeball, it seemed to me she was dead. A quick pulse check confirmed this. So we put her on the ground (we were outside) and went to work. I most impressively (purposefully overly self-promoting) got the tube on her Mallampati 1 airway. CPR was initiated. (this was before that whole “concentrate on quality BLS” movement.) I went to hook her up to the monitor/defibrillator, and noticed that she had moved…Several feet…Towards the truck…Not on a stretcher… About the same time I noticed the crowd forming an ever shrinking circle around us. Being “a Yankee” myself, and having worked in ‘hoods prior, the fact this patient was of black skin had absolutely no consequence to me. Black, white, green, yellow, purple, gay, straight, rich, poor, none of that stuff ever mattered before. Honestly, it never occurred to me this would be anything other than another arrest to work. But steadily while pausing now and again to do CPR, check the tube, start an IV, we continued to drag the patient across the ground into the back of the truck (ambulance). These particular trucks had no way to get from the back to the front, except by exiting the truck, which I quickly discovered to be impossible because of the people outside the truck beating on it and yelling. The look on my face must have been incredulous, because I am not sure who or when the doors were locked so we would remain in our little “safe room” I was then let in on the secret. “Black people here do not think white people try very hard to help them.” So the default reaction is anger and aggression. After a few months, it did not escape my notice they probably had some legitimacy to that assumption, though it was more of an exception than a rule.

About now I get all kinds of hate mail from Southerners about how racism doesn’t exist in their part of the US. It does. I have seen it. The only people treated worse are gay people. It is systemic, from management to the rank and file, in the agency and out. The first step to fixing a problem is identifying you have one. Spare me the “not us” comments. Many of those people who were victims should have filed discrimination lawsuits.

Now that you have some background, let me get right to the point. In the old days, when you acted like an asshole, the solution was usually somebody kicked your ass. It wasn’t personal, and generally you didn’t repeat the behavior.

But those days are gone. Now we are civilized and nonviolent. Supposedly…

Some weeks ago in Arizona, a video of firemen beating up on a postictal seizure patient went viral. I don’t know where it stands today, but I would venture that a settlement is going to be paid. Somebody might even get in trouble.

One of the projects that I am honored to be a part of is DT4EMS. It is a course designed by, in my opinion at least. The world’s leading expert on EMS safety and use of force. My role is actually really small. I edit the manual. But after reading it 4 times while doing the edits, I have learned a thing or two about the topic. This has had the side effect of me becoming more aware and even critical of violence against providers and the response of the providers, management, law enforcement, courts, etc. In this course (which I have absolutely no financial interest in, I just think it is brilliant and quality and I am honored to volunteer to help in my small way)it talks about the legal aspects, public relations aspects, documentation, and even has some easy to remember self-defense techniques which are designed not only to permit defense and escape, but are formulated so they do not look aggressive and are not offensive. (one of the best pieces of advice I was ever given in my career was: If you ever want to know if you are doing the right thing, just ask “how is this going to look on the 6PM news?”) DT4EMS meets the 6PM news test. But like all self-defense courses, one of the things it stresses is not to put yourself in a bad situation to begin with.

So…Writing hateful things on the internet for the whole world to see, makes people want to kick your ass.

Violence against healthcare providers is on the increase world-wide. It is a major problem. It has been noticed that providers are losing the respect and neutrality of the populations they serve. I could probably write a paper or even a small book as to why.

For now, let’s stick to one part? Instead of being benevolent and neutral, healthcare providers have rebranded themselves as the defenders of the true faith and morality. Then, after they talk smack on the internet, use sarcasm, and show utter disdain for various patients and populations, everyone sits around and bemoans what a tragedy this violence on providers has become.

Let me help you out. If you want to stop violence against providers, before we get into martial arts, laws, dumbasses suggesting carrying firearms, take a look in the mirror. Do you treat patients and the public in a way that would make somebody want to kick your ass? If the role were reversed, would you want to kick the person’s ass that was treating you that way? Do you perform different treatments on those you don’t like vs. those you find “acceptable”? When you start spouting hatred against races, legal status, people with different morals, low education, poor, and all the things you don’t like or agree with, YOU are making violence against providers more likely. When YOU post that on the internet it disparages the long traditions and sacrifices of the people who came before us. Yes, you have a right to free speech, but you also have responsibility. That includes not making your whole profession or vocation look like a bunch of arrogant assholes that don’t care about people or treat them poorly.

I would also make special mention that in many countries, your internet postings can and will be used against you in court. So when you start carrying on about how you don’t like criminals, blacks, Hispanic, gays, whoever; when you start posting about administering normal saline and telling patients it is a pain medication; when you start boasting on how you under-treat patients because they are drug seekers who never pay their bill and it comes out of your tax money, those posts might make their way into a lawsuit or criminal case against you. It is also not good if your photos have your agency logos all over them. It makes the whole agency look bad.

Simple ending: Stop doing that! Because whether you are a doctor, a nurse, a paramedic, a firefighter, police officer, or whatever; you are making things bad for everyone else. If you don’t like the people you have to deal with at work, find another job. Find another career. Not only will it make you happier, reduce stress, and increase life expectancy and quality; the rest of us don’t need you. Our respective professions/vocations have gotten along without you before; they will get along fine, perhaps better, after you are gone. If you need to vent as we all do from time to time, do it privately! Not on a public website where the whole world can see and record it.