Thursday, November 19, 2015

The Tired, Poor, and Huddled Masses

The outcry to ban Syrian migrants from the United States based on the possibility that one of the terrorists involved in the French attacks may (an I emphasize "may") have had a valid Syrian passport reminds me of the cries during World War II that helped restrict, if not eliminate, the acceptance of Jews attempting to escape the massacres perpetrated by Nazi Germany.  Not only was immigration  severely restricted, in part because similar fears of enemy infiltration, but Italian, German, and Japanese nationals, as well as those American citizens of the aforementioned ethnicities were interned or otherwise restricted.

German citizens were often detained as were American citizens of German descent.  Many were removed from residences in coastal areas.  A total of 11,507 Germans were interned during the war.  110,000 Japanese-Americans were interned.

Italian nationals in the United States during the war were also interned.  Classified as "enemy aliens" they were detained under the Alien and Sedition Act.  A total of 1881 were so detained, and a number of them were also relocated from coastal areas.

I am unaware of any seditious act that was proactively prevented by this relocation and internment policy.

We now have a decision to make.  Will we ban all immigrants from the ravaged countries of the Middle East as a means of protection from ISIS terrorism?  Hypothetically, If we knew that 5 terrorists were planning to enter this country disguised as Syrian refugees, should all refugees be banned?  Even if a terrorist was able to kill some Americans, should we close our borders completely?  As a matter of fact, isn't it possible that a terrorist could enter the United States as an ordinary tourist?  And, furthermore, should we remove Arab muslims from coastal and densely populated areas?

Are we a society that is now ready to close its borders to the "tired, the poor" and the "huddled masses yearning to breathe free."

The world has become a dangerous place.  ISIS must be contained and/or eliminated, and the means by which this can be brought about is unclear.  But to close our doors and enclose ourselves in a tight protective shell that thousands of innocents will be prevented from penetrating, is clearly not a solution.  It is surrender.

Monday, November 9, 2015

Questions a Doctor Should Answer

Doctors should answer a patient's questions.  Doctors should invite questions and ask patients to come prepared with questions.  If a doctor does not know the answer to a question, he should volunteer to get back with the answer.  Doctors should never minimize the importance of a question, no matter how trivial it may seem.   Doctors should understand that a patient may be upset, may not understand what is being related to him, and may need time to compute the information being provided.

Doctors should make certain that patients fully understand what has been told them.  Studies have shown that a patient's comprehension and retention of the issues discussed is unreliable - frequently forgotten and/or misunderstood.  Patients should write down (or perhaps record) what the physician is saying and review these notes with him before departing, insuring comprehensive certainty.   Even better, bring along a relative or friend.  Four ears and two brains are far better than two ears and one   brain - especially if the information is serious and complex.

Questions for the physician might include:
  1) What are the risks/benefits of the prescribed therapy?
  2)  How successful has this therapy been? Are there other forms of therapy to consider?
  3)  How common is my problem?
  4)  If an invasive procedure - what are the chances of complications or death?
  5)  How many procedures (if a procedure is to be done) have you performed?
  6)  How many patients with my problem have you treated?
  7)  What is the followup for my treatment or procedure - how often may it have to be repeated?
There may be others, specifically targeted to the medical issue at hand.  There may also be time constraints and, perhaps, another visit for questions and discussion should be scheduled.

Commendably, many physicians will have proactively covered these questions in their discussions
having anticipated the patient's appropriate concern.  But if not, one should not be afraid to ask.

Remember - as the doctor is interviewing you, you are simultaneously interviewing him.

Friday, October 23, 2015

Trump, Carson, and Joseph N. Welch

"You've done enough. Have you no sense of decency, sir? At long last, have you left no sense of decency?"

These famous words, the words of Joseph N. Welch, the Boston attorney representing the United States Army during the widely-viewed (and infamous) Army-McCarthy hearings in 1954, were directed at Senator Joseph McCarthy of Wisconsin.  McCarthy had just accused a member of Welch's law firm of having been a member of the Communist Party during his youth.

It's time that at least one of the Republican presidential candidates level a similar condemnation of the spiteful, indecent, and ignorant words of Donald Trump and Ben Carson.  Trump certainly has no understanding of "decency" - ridiculing his opponents for their appearance, or for their manner of speech, or because of a tendency to perspire.  But the nadir came when he inferred presidential guilt for 9/11 -  holding President George W. Bush responsible for the event.  Outrageous!!  Yes, he was our president at the time- in office for a total of eight entire months!  And yes, President Roosevelt was in office in 1941 when Pearl Harbor was attacked - and perhaps President Lincoln should be held responsible for the Civil War which began one month into his presidency!

Carson's comparing the United States to Nazi Germany is similarly outrageous.  Peter Wehner, in his New York Times op-ed piece on October 20 characterized Carson's remarks as showing a "staggering ignorance when it comes to the unique malevolence of Hitler's Germany."

"Staggering ignorance." An "imbecilic historical analogy," writes Wehner.

Carson went on to opine as to how Jews in Germany could have survived the Holocaust if only they were permitted to have guns!

"Staggering ignorance."  An "imbecilic historical analogy."

Mr. Trump, Dr. Carson - you've done enough.  Have you no sense of decency, gentlemen.  At long last have you left no sense of decency?

Wednesday, September 30, 2015

What Pope Francis Didn't Say

Everyone loves Pope Francis - engaging, smiling, a man of the people - humble, loving - and a man of peace. Francis possesses a special charisma and "stage presence" unique to his office.  Francis has filled his recent visit to The United States with pleas for peace, for ending poverty, for the caring of the young, the sick, and the old.  He, in other words, echoes the hopes of humanity.  Who can possibly be opposed to any of these pleas and hopes!

But words are not actions - and some words lack specifics.  The very controversial Pope Pius XII, whose papacy spanned the era of Nazi Germany and World War II, also prayed and preached for peace and love.  What he did not do, and why "controversial" is applied to his papacy, is that he failed to name names.  He never directly condemned Hitler's policies, nor Mussolini's.  He never denounced the Nazi perpetrators of the mass murders and human extermination that occurred during his papacy. His words may have made a difference, above all since many of the perpetrators were Catholic.

A general damning of war, human suffering and poverty- that's easy.  What's difficult is directing such condemnation at those actually known to be at the root of human suffering.   Like Pius, Francis has failed in this regard.  As Pius failed with Hitler and Mussolini, so Francis is failing with Assad, with Khamenei, with Al Quaeda, with ISIS - and with all others responsible for the terrorism, murder, and genocide that plagues humanity today.  Francis urges us to care for and to empathize with the teems of migrants desperate to find security and stability in Europe, but castigates no one responsible for this extraordinary display of despair.  It is a noticeable silence.

The world knows the power of papal speech.  Words matter.  And the words of a pope, particularly such a beloved and charismatic pope, carry great moral weight.  As we listen to his words, we must also listen to his silence.

Thursday, September 17, 2015

How To Pronounce "Los Angeles"

Ilan Stavans's recent op-ed article in the New York Times (Sep 17)  discusses the American TV reporter Vanessa Ruiz's (an anchor for 12 News, Phoenix Arizona) insistence on pronouncing words and names that have a Spanish derivation in the Spanish manner.  So, for example, her name RUIZ would be pronounced not as an anglicized ROO-iz, but in the Latino style  Rrroo-ISS (with a rolled "r").

When Latino names and terms are pronounced by reporters or anchors with Latino backgrounds, they often assume that such names are preferably voiced in the Latino style.  I hope they checked with the persons involved, because he/she may prefer the anglicized version rather than the Latino.   I have never heard Senator Ted Cruz or Senator Marco Rubio pronounce their names using Hispanic rolled "r's".   Their names are always anglicized when spoken to an American audience, which I feel rather confident in saying is the usage they prefer.

I once made the mistake of Italianizing a patient's surname, believing it would be the preferable form of address.  I was dead wrong -- immediately corrected by the patient, who went on to pronounce his name using his preferred anglicized style.

My name,  STEEG,  is of German origin and in Germany is pronounced SHTEHG.  I certainly do not prefer this to the anglicized form (rhymes with "league") and would resent an assumption that the German form is proper when used in the setting of an American conversation or discourse.

Stavans concludes his op-ed piece with the following: "Ms. Ruiz's use of Spanish pronunciations reflects the new social reality in which Shakespeare's tongue must adapt."


The names of people and places should be pronounced according to the wishes of those bearing those names or living in those places. The American city is Los AN-gel-ess, not Los AN-hel-ess, and the American state is Mon-TAN-ah, not Mon-Tahn-ya!  Spanish derivation - yes.  Spanish pronunciation - no.

Sunday, September 13, 2015

Malpractice - Myth or Reality

A recent NY Times Op-Ed piece entitled "Legislative Malpractice" prompted a number of contrary Letters-to-the Editor.  These included critiques of juries of lay people who, the writer, averred, do not possess the proper credentials to adequately judge complex medical cases.  Another noted that defending malpractice suits costs the health care system "hundreds of millions of dollars each year," and many are without merit.  Myths or reality?

Some facts:

1.  Researchers at Harvard School of Public Health have found that 97% of malpractice suits were meritorious.  There is little "frivolous litigation" in malpractice suits.
2.  The Institute of Medicine has estimated that 98,000 patients die each year as a result of preventable medical errors and hundreds of thousands more suffer nonfatal injuries.  Other estimates are as high as 210,000-400,000 such deaths each year (Journal of Patient Safety 2013).  Despite these numbers, malpractice suits comprise only 3% of all tort caseload.  Only 30% result in a lawsuit.  There are, then, far more instances of documented malpractice than there are malpractice lawsuits.
3.  No more than 0.5% of malpractice payments resulted in an award of $1 million or more.
4.  Despite the non-possession of "proper credentials" by jurors, a 2006 study discovered that juries found for the  plaintiffs only 21% of the time.  (By the way, "improperly credentialed" juries are also asked to decide complex financial issues, contracts, and other forms of very involved civil litigation.)
5.  Medical negligence compensation accounts for only 0.3% of national healthcare costs.
6.  So called defensive-medicine expenditures (ordering "unnecessary tests" to counter potential malpractice suits) do not result in a significant cost increase compared to total health expenditures.
7.  Malpractice premiums, which are primarily driven by the general economic insurance cycle rather than by large malpractice awards, cost a typical physician just 3.2% of total revenue - far less than his/her rent.
8.  Since 1987 medical costs have increased by 113%, while malpractice insurance has increased by just 52%.
9.  Some states have adopted "collateral-source offsets" - costs covered by health insurance not recoverable by malpractice plaintiffs.  With increased insurance coverage, greater "offsets" are expected, resulting in lower total indemnity payouts.

Last fact:

Many so-called malpractice issues are clearly more myth than reality.  Competent physicians, who know what they are doing and how to do it, need have no malpractice qualms!

Thursday, September 3, 2015

The Kentucky Clerk and Dred Scott

Kim Davis, the Rowan County (Kentucky) clerk of courts is denying marriage licenses to same-sex couples, doing so, as she has stated, on "God's authority."  Ms. Davis, whose deeply religious convictions oppose such marriages, is clearly in violation of the Supreme Court's landmark ruling in Obergefell v. Hodges whereby the constitutional right to same-sex marriage was affirmed based on the Fourteenth Amendment.

Ms. Davis's legal advisors have argued that, in fact, the decisions not to uphold Supreme Court rulings without supporting legislation has precedence in the famous Dred Scott case.

And, as a matter of fact, Davis's legal team has a point.

To review, Dred Scott, was a slave in the service of John Emerson, a member of the US military, who moved from Missouri (a slave state) to Illinois and Wisconsin (free states) in 1834.  Though Emerson eventually returned to Missouri, Scott maintained that his residence in a free state had freed him from slavery bonds.  The case finally worked its way up to the Supreme Court.  In 1857, Chief Justice Roger Taney, writing for a 7-2 majority, ruled that Scott had no standing to sue in a federal court since people of African descent (slaves) were constitutionally not citizens of the United States. He concluded that the Declaration of Independence was never intended to pertain to slaves.  Slaves, he continued, being, in fact, property, remained so in whatever state their owners may reside.

The Dred Scott decision helped launch the Civil War, and became what is considered the worst Court decision in U.S. history.

Northern courts and politicians rejected "Scott"as binding. The Ohio Supreme Court ruled that any slave coming into the state with his master’s consent, even as a sojourner, became free and could not be reenslaved upon returning to a slave state; the New York Court of Appeals handed down a similar ruling in Lemmon v. The People (1860). In several states, legislatures resolved to prohibit slavery in any form from crossing onto their soil and enacted legislation freeing slaves passing within their borders.  Abraham Lincoln, himself, did not follow this ruling. With his Emancipation Proclamation  he claimed the executive right to free slaves in the rebellious states.

So, in fact, the "law of the land," was not followed in Northern jurisdictions.  The case remained "the law of the land" until "overturned" by the passage of the Fourteenth Amendment following the Civil War.