Wednesday, January 7, 2015

Most Doctors Don't Listen to Patients



"Dr. Martin" is the vignette below is in all likelihood a clinical psychologist. We rule.


NYT
"HARRISBURG, Pa. — BETSY came to Dr. Martin for a second — or rather, a sixth — opinion. Over a year, she had seen five other physicians for a “rapid heartbeat” and “feeling stressed.” After extensive testing, she had finally been referred for psychological counseling for an anxiety disorder.
The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.
...

[C]ommunication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.
A doctor’s ability to explain, listen and empathize has a profound impact on a patient’s care. Yet, as one survey found, two out of every three patients are discharged from the hospital without even knowing their diagnosis. Another study discovered that in over 60 percent of cases, patients misunderstood directions after a visit to their doctor’s office. And on average, physicians wait just 18 seconds before interrupting patients’ narratives of their symptoms."


Tuesday, January 6, 2015

What are the obligations of citizenship?

Socrates knew his civic duty. He didn't make a fetish of his civil rights.

Note that 75% of Americans said that voting is "a very important obligation," but only 36% of eligible voters showed up at the most recent national election. It would be interesting to see what people would spontaneously volunteer if they were asked, "What are your RIGHTS as an American citizen?" The following question should be, "What are your DUTIES as an American citizen?"

Interesting to recall what the Athenians considered the duties of citizenship: Being married, having children, being financially independent, owning the arms necessary to defend the city, training regularly in the use of those arms, and participating in debates in the assembly.


ABC News
"An Associated Press-GfK poll repeated questions asked in 1984 about six civic-minded activities: voting, volunteering, serving on a jury, reporting crime, knowing English and keeping informed about news and public issues.
Of the six, only voting and volunteering were embraced about as strongly as three decades ago, when NORC at the University of Chicago posed those questions to Americans on the General Social Survey, but volunteering doesn't rank very high on the list for many.
While just 28 percent say volunteering is "a very important obligation" that a citizen owes the country, three-fourths of Americans consider voting central to citizenship.
Nonetheless, only about 36 percent of eligible voters turned out for November's midterms, according to University of Florida Associate Professor Michael P. McDonald's analysis. That's the lowest since World War II.
———
BUT BIG MAJORITIES STILL FEEL AN OBLIGATION
Despite some sliding, Americans still think U.S. citizenship carries some duties as well as rights.
About 9 out of 10 say that reporting a crime you witness, voting in elections, knowing English and serving on a jury when called are at least "somewhat important" obligations.
And each of those is still rated "very important" by a majority. It's just that, except in the case of voting, those majorities have slipped by an average of about 13 percentage points.
"There are a lot of arguments about how our society has shifted toward a rights focus instead of an obligation focus," said Scott Keeter, director of survey research at the Pew Research Center. But Keeter isn't convinced there's enough evidence to support that conclusion.
"It's a little early to pull the alarm bells about the demise of our civic culture," he said.
———
SENSE OF DUTY LOWEST IN THE YOUNG
Young people are feeling less dutiful, or maybe just showing their libertarian streak.
In every category except volunteering, adults under 30 were less likely than their elders to see any obligation, and also felt less obliged than young people of the past.
In 2014 about a fourth of them said there's no duty to keep informed, volunteer or speak English."


Monday, January 5, 2015

The Tragedy of the American Military -- James Fallows

 

James Fallows has a lot worth reading in this article, from our popular culture's unfortunate inability to poke fun at the military, to the corrosive influence of the military-industrial complex (F-35, anyone?). He also repeats the observation that despite the repeated failures to achieve victory in either Iraq or Afghanistan, not a single American commander has been relieved of a combat command since at least 2001.
"Ours is the best-equipped fighting force in history, and it is incomparably the most expensive. By all measures, today’s professionalized military is also better trained, motivated, and disciplined than during the draft-army years. No decent person who is exposed to today’s troops can be anything but respectful of them and grateful for what they do.
Yet repeatedly this force has been defeated by less modern, worse-equipped, barely funded foes. Or it has won skirmishes and battles only to lose or get bogged down in a larger war. Although no one can agree on an exact figure, our dozen years of war in Iraq, Afghanistan, and neighboring countries have cost at least $1.5 trillion; Linda J. Bilmes, of the Harvard Kennedy School, recently estimated that the total cost could be three to four times that much.
... 
Yet from a strategic perspective, to say nothing of the human cost, most of these dollars might as well have been burned. “At this point, it is incontrovertibly evident that the U.S. military failed to achieve any of its strategic goals in Iraq,” a former military intelligence officer named Jim Gourley wrote recently for Thomas E. Ricks’s blog, Best Defense. “Evaluated according to the goals set forth by our military leadership, the war ended in utter defeat for our forces.” In 13 years of continuous combat under the Authorization for the Use of Military Force, the longest stretch of warfare in American history, U.S. forces have achieved one clear strategic* success: the raid that killed Osama bin Laden. Their many other tactical victories, from overthrowing Saddam Hussein to allying with Sunni tribal leaders to mounting a “surge” in Iraq, demonstrated great bravery and skill. But they brought no lasting stability to, nor advance of U.S. interests in, that part of the world. When ISIS troops overran much of Iraq last year, the forces that laid down their weapons and fled before them were members of the same Iraqi national army that U.S. advisers had so expensively yet ineffectively trained for more than five years."

*I would characterize the assassination of OBL as more of a symbolic victory than a "strategic" one. I would also characterize the overthrow of Saddam Hussein as "strategic," not merely tactical. But it's a damned shame we didn't immediately partition Iraq into three countries, install puppet strongmen, and then get the hell out of there by 2005.








Sunday, January 4, 2015

Three Things to Remember -- William Blake (1757-1827)



A Robin Redbreast in a cage,
Puts all Heaven in a rage.

A skylark wounded on the wing
Doth make a cherub cease to sing.

He who shall hurt the little wren
Shall never be beloved by men.                  



          

Saturday, January 3, 2015

Cannonball -- The Breeders (1993)

Yeah, they're identical twins.



Check, check, check
One, two, one, two
 
Spitting in a wishing well
Blown to hell, crash
I'm the last splash

 I know you, little Libertine
I know you're a real koo koo
 
Want you, koo koo, cannonball
Want you, koo koo, cannonball

 Hey now in the shade, in the shade
Hey now in the shade, in the shade
 
I know you, little Libertine
I know you're a cannonball

 I'll be your whatever you want
The bong in this reggae song
 
Hey now in the shade
Hey now in the shade

 Want you, koo koo, cannonball
Want you, koo koo, cannonball
 
Spitting in a wishing well
Blown to hell, crash
 I'm the last splash

 I'll be your whatever you want
The bong in this reggae song
 
Want you, koo koo, cannonball
Want you, koo koo, cannonball

 Hey now in the shade, in the shade
Hey now in the shade, in the shade

Songwriters
Deal, Kim
 
 
 


Friday, January 2, 2015

Pepper -- Butthole Surfers (1996)






Mikey got with Sharon, Sharon got Sheriee
She was sharin' Sharon's outlook on the topic of disease
Mikey had a facial scar and Bobby was a racist
They were all in love with dyin' they were doin' it in Texas
 
Tommy played piano like a kid out in the rain
Then he lost his leg in Dallas he was dancin' with the train
They were all in love with dyin' they were drinkin' from a fountain
That was pouring like an avalanche coming down the mountain
 
(chorus)

 I don't mind the sun sometimes the images it shows
I can taste you on my lips and smell you in my clothes
Cinnamon and sugar-y and softly spoken lies
You never know just how you look through other people's eyes
 
Some will die in hot pursuit and fiery auto crashes
Some will die in hot pursuit while sifting through my ashes
Some will fall in love with life and drink it from a fountain
That is pouring like an avalanche coming down the mountain
 
(chorus)

 I don't mind the sun sometimes the images it shows
I can taste you on my lips and smell you in my clothes
Cinnamon and sugar-y and softly spoken lies
You never know just how you look through other people's eyes
 
Another Mikey took a knife while arguing in traffic
Flipper died a natural death he caught a nasty virus
Then there was the ever-present football player rapist
They were all in love with dyin' they were doin' it in Texas
 
Paulie caught a bullet but it only hit his leg
While it should have been a better shot he got him in the head
They were all in love with dyin' they were drinkin' from a fountain
That was pouring like an avalanche coming down the mountain
 
(chorus)

 I don't mind the sun sometimes the images it shows
I can taste you on my lips and smell you in my clothes
Cinnamon and sugar-y and softly spoken lies
You never know just how you look through other people's eyes

Songwriters
BENNINGTON, CHESTER CHARLES / BOURDON, ROBERT G. / DELSON, BRAD / SHINODA, MIKE / FARRELL, DAVE / HAHN, JOSEPH
 
 
 

Thursday, January 1, 2015

Wot -- Captain Sensible (1982)

Dolly Mixture -- the background singers on this track



When I woke up this morning I was feelin' fine
But this cat starts banging man what a swine
So I called reception but to no avail
That's why I'm telling you this sorry tale

It went bang, I said, "Shut up"
It went bang, I said, "Rap up"

Well, I'm aware that the guy must do his work
But the pile driver man drove me berserk

He said, "Captain", I said, "Wot?"
He said, "Captain", I said, "Wot?"
He said, "Captain", I said, "Wot?"
He said, "Captain", I said, "Wot do you want?"

Once a lifetime, twice a day
If you don't work you get no pay
I been to the east, I been to the west
But the girls I like best are the ones undressed

Well, hello Adam, where you been?
I said, "A'stand aside 'cause I'm feelin' mean"
I've had a gutful of you and I'm feelin' bad
'Cause you're an ugly old pirate and ain't I glad

He said, "Captain", I said, "Wot?"
He said, "Captain", I said, "Wot?"