Racism/Sexism in Health Care

Someone sent me a full copy of this article from WebMD. The research found that only a minority of minority members actually preferred a physician of the same race or ethnicity as their own. The majority had no preference. For African-Americans who had a preference, the reason was based on a belief that there is inherent racism in the American health care system.

The authors agreed that there is a pattern of undercare for minorities, that is, some comparatively small percentage will receive less than optimal care. However, the overwhelming majority of minority members do, in fact, receive excellent care in the current system.

The authors apparently think that there should be less emphasis on trying to recruit and train more minority doctors and instead work with the patients who are uncomfortable with the system to make them more comfortable--or something like that. When I got to this quote, my brain shut down, and I decided that they needed to rework their analysis a tad.

"Say a white person comes in and says, 'I only want to see a white doctor.' How comfortable are we with this?" van Ryn says. "And another problem is right now, blacks are a minority of doctors. And for black patients always seeing one, even if we had an equivalent ratio of black doctors to the black population, it is not going to work out. And what about Native Americans, and those who want women doctors? So while I think it is extremely important to have the health care work force represent the population being served, I am not sure [matching patients to doctors by race] is viable."

You can see from the emphasis that I added what set me off. I just remembered an exchange that I had with the male HMO doc that I used to see:

Me: I'm having chest pains.
Him: Let's do the hysterectomy first and then we'll deal with that.

"That" was the referred pain from a seriously bad gall bladder, which had to be removed less than eight weeks after the hysterectomy.

Compare that to the exchange with the female PPO doc that I see now:

Me: I'm having chest pains.
Her: Let's do an EKG.

And then she followed it up with a referral to a cardiologist.

Somehow, I don't think it's the HMO vs. PPO issue that makes the difference. Indeed, we now pay more for a PPO so that I can see a woman doctor.

No Draft for Darfur

Not that I think there will be a military draft anytime in the foreseeable future, but some military planners might be secretly wishing there were one. Or maybe it's political planners who would be engaging in the wishful thinking when there aren't enough bodies in the military to carry out their political objectives.

Helen Thomas writes that military recruitment is now being met with "disinterest." She notes that the Army and the Marines may have trouble making their annual recruiting goals and that the National Guard will surely miss its goal. Minority youth and women are increasingly reluctant to join up.

Thomas attributes this to the shift in purpose for the war in Iraq. There was more willingness to join up and serve when there was a perception of threat to the U.S., less willingness when the purpose is to "liberate" Iraq.

Reminding us of the saying from the Vietnam days ("Someday they'll give a war and nobody will come"), she also points out that a draft is unlikely and finds the quotes to shore up the point. Her conclusion is nicely done:

Compulsory military service is politically unpalatable -- and more so in an unpopular war. Although the administration has done a masterful job of shielding the public from photos of the coffins of the dead flown into the Dover, Del., military mortuary, the reality of war is getting through.

If the Army continues to be all-volunteer and enlistments keep falling, the good side of the equation is that it could force Bush and his saber-rattling strategists to slow down before launching another pre-emptive foreign adventure.

Bush may then try something new -- like peacemaking.

It almost seems like old news to be thinking about Iraq these days. The new news is Terri Schiavo and steroids and the really, really serious, almost-any-day-now-imminent collapse of Social Security. But there is other more or less new news lurking about--like Darfur. I can't help feeling that the Sudan would be a better place for American troops right now--if we had enough. But we don't, of course, because we're wasting them in a war that has no clear purpose, that was planned on false intelligence, that didn't include a plan for peace, and . . . well, it's all been said, hasn't it?

The thing is, we knew about Idi Amin and the horrors that he perpetrated--and we sat still. We knew about Bokassa--and let that get worse and worse. We knew about Rwanda--and just wrung our hands in sorrow. So now it's Darfur.

There may be some intellectual inconsistency here. I'll have to think about my unhappiness with military intervention in Iraq versus my thinking that we need to do something about Darfur. In the meantime, I'll also ponder the notion that the Sudan also has oil--but the major oil concession in the Darfur region belongs to China--which holds a fair amount of our national debt. Yet another reason, I suppose, to stay away from that draft thing.

Decision Point

My Prince and I looked at each other last night after the network news ended. I asked: "So do you have any questions about my intentions regarding my living will?" He said: "Nope. Pull the plug. Do you have any questions about mine?" And I said: "Nope. Pull the plug."

The ongoing spectacle surrounding Terri Shiavo is disturbing on a number of levels, but it has committed me even more firmly to my belief that death is a part of life. We are born, we live as best we can, and then, like all good things, it comes to an end. I am not yet ready for that end, but I know that it will come sooner rather than later. I would prefer that it come suddenly and not be the long, drawn out affair that it could be under the circumstances. But, if it becomes that long, drawn out affair, I hope My Prince will have the courage to know that the time to end it has come and will let me go.

I say this will full understanding that I am suffering from the loss of so many that have been dear to me. I looked up from my computer at my office yesterday and realized that the bulletin board that hangs in front of me is full of pictures of dead people. My house is filled with mementos of loved ones. I cling to my father's tools, cherishing even a screw driver, because he worked with it. This all probably contributes to a fair amount of depression, I would guess.

But I know from my own experience that there is a time to let people go. It's their memory that I cling to--I would not hold them to a life of pain and suffering.

In about three weeks, on April 15, we will face the ninth anniversary of my father's death. I still vividly recall the day. The morning phone call. The frantic drive to Houston. The race through the halls of the hospital. And standing in the waiting room as my mother handed the phone to me so that I could talk to the doctor. She could not make the decision that needed to be made, so she gave the responsibility to me.

My father had had a massive stroke. If he lived, he would be unable to speak. He would not be able to feed himself. He might not know anyone or anything. He likely would have to be confined to a nursing home. These were things that I knew my father would not want. He was always the caregiver; were he aware of what was going on, he would hate to be the one being taken care of. He would hate the weakness, the helplessness, the loss of dignity.

The doctor wanted to know if we wanted him to continue to try to keep Daddy alive. In the end, I was the one consoling the doctor, reminding him that he had already kept Daddy alive for years with drugs and baling wire. Daddy was worn out. I think he had been waiting to die for some time. And I told him to let Daddy go.

I sat beside my father then. I talked to him, telling him that we would take care of Mama, that he didn't need to worry any more. I suppose that we fool ourselves about the things that we want to believe. He never regained consciousness, so there is no way to know that he heard me or that it mattered what I said. Still, not long after I talked to him about taking care of Mama, he drifted away. Sometimes I feel it was the words as much as the medical decision that let him go in peace. He'd given so much of his life to taking care of my mother, it was almost as if he wouldn't let go until he knew that someone else would take up where he left off.

I cannot judge Terri Shaivo's parents. I shouldn't anyway. But I cannot see myself being so selfish that I would want someone that I loved so very much to live in pain or suffering just so I could cling to them.

I do, however, judge those who have tried to intervene in this family's agony. When the day comes that I or My Prince has to make a decision regarding the other, neither of us would take very kindly to having the courts or Congress having an opinion much less taking any action regarding our decision. I know that much of the intervention has been for political purposes, and the media circus is just that--a circus. Still, there seems now to be some possibility of all this right-to-life nonsense spilling over into yet another area of personal decision making. That's not right.

The Long Goodbye

We're taking a small breather around our house today. I have "sick leave" for some doctor's appointments, and My Prince--well, he never seems to get a breather, actually. He's messing with some "toys" in the garage (he calls them "tools," but they're still toys) right now, but soon he'll be off to do yet another good deed for one of our elders.

But, in a sense, he, too, will be getting a small break from the work of the past few weeks, which has been one more step in saying goodbye to his mother. Two weekends ago, we had the family together to select the items in his mother's home that they wanted. Last weekend, we completed the work of emptying her house and getting it ready for sale. On Tuesday, he closed the sale, which gives us a tough milestone in our goodbyes.

Going through the house with the relatives was a bit of a zoo. I preferred a bit more orderly process than what occurred, so the event was somewhat stressful for me. Not the least of the stress was wondering what value various people were actually placing on the things that they took. At least one seemed somewhat mercenary. Except for one or two things that were particularly special to My Prince and me, we generally stood back to let the others have their choices.

The irony, of course, is that we were more than satisfied with the "leavings." We had already looked through the house and had the opportunity to look at how things were arranged, how my mother-in-law ordered her life, the things that she thought were worth holding on to. It was a chance to get to know her better and gather more memories to treasure. After the family event, things were in serious disarray, but we had the responsibility of packing up and disposing of the remainder. We were surprised at how much stuff was buried in the back of closets and hidden away on shelves. My mother-in-law had more storage space that we realized, and she used it all.

The packing up took several days. We didn't expect there to be quite so much to pack, but it was quite astonishing. On one day, we loaded my car up entirely with items for Goodwill. My Prince's car was loaded up with garbage and recycling. The garbage haul was because the area where my mother-in-law lived would only remove one small can of garbage per week. We had to haul things back home and pay for the extra bags, but at least we could get it disposed of. And the recycling? My mother-in-law saved every plastic container that came her way. She saved bread bags. She saved the zipper bags that tortillas and other foods come in. She saved canning jars and jars that could be made to work for canning. I filled at least 5 tubs of recycling from her kitchen and laundry room. I also filled up two large sacks of recyclable plastic bags. And wire hangers! A couple of bags of those, too.

Her thrift extended to other areas as well. Many of the items that we found in her closets and drawers were brand new, some even with the sales tag still on them. Many of these we could identify as things that we had given her in the past. There were an astonishing number of gifts when we thought about it. Birthday, Christmas, Mother's Day, Valentine's Day. I also sent presents when My Prince went to visit and I couldn't come along. Little things mostly--and she saved them all. Many were clearly still unused. But she kept them and, I hope, enjoyed the thought that went with them.

What we also found were many items that had been used and reused well past the point of ordinary usefulness. Her dishrags were rags. Her dishtowels were old pillow cases. Her bath towels were quite worn--even when there were at least two dozen brand new towels still in the cupboard. There were at least three brand new robes hanging in her closet, one with the price tag still on it. Nice fleecy warm robes. What she apparently wore was thin and clearly old.

While we were cleaning and clearing out, the weather would change from cold to warm and back again. Whenever the clothes I had with me weren't suitable for the weather, I just went to her closet to see what might fit me among her work clothes. My favorite must have been one of hers as well. A nice soft and faded pair of jeans with a patch on the behind.

The kitchen took a lot of time because my mother-in-law was a grand cook. I now have two boxes of cookbooks and a huge number of recipes that she wrote out by hand or clipped from various sources. Another room that took quite a bit of work was the sewing room, because she was also a fine seamstress. Aside from the many yards of material and boxes of sewing notions (an entire box of elastic, another of buttons), there was a whole wall of shelves and drawers to be gone through.

The shelves held great treasures. Two matching coffee mugs with My Prince's grandparents' names on them. Lovely brass decorative items. Some old crystal pieces. And, zipped up in a bag from a funeral home, a worn and tattered copy of The White House Cookbook, signed by her mother in 1905.

We had to let go of some things. We could not handle the two refrigerators or the freezer. Those went to the Salvation Army, along with assorted wigs, sticky Tupperware, and other items.

Still, we kept a great deal. Our house is now full of boxes and bags and extra furniture. Some of it will replace our own rather tatty items. The grandson was apparently thrilled to get our old sofa and recliner. We are similarly thrilled to get a couch that our late and beloved cat had not christened at every available opportunity. We will really enjoy the porch swing. I will find some way to cram in more cookware--even though I am not nearly the cook that my mother-in-law was. (Fortunately, My Prince will eat anything.)

We will also give more items away. Some to my mother, some to family friends, some to my husband's stepmother (yes, she and my mother-in-law were actually friends). There is a whole garbage sack full of "old lady" purses. A huge box of shoes. A couple of closets worth of clothes.

Right now we are very slowly unpacking and sorting what we brought home. My Prince just came in to show me a small rubber tire. (Apparently there really are toys in that garage!) When he was a child, he apparently accompanied his parents to the Firestone store. The small rubber tire was then part of an ashtray. He must have played with that tire so much that the store owners gave it to him for a toy. The glass broke sometime over the years, but the rubber still looks new--even 50+ years later--and now My Prince has found another treasure. We'll have to find a dish of some sort to fit inside the little tire so he can put paper clips or something in it.

When my father died, I couldn't bear to let go of anything that he had ever touched. I wanted so much to keep him near me. I suppose I was trying to escape the fact that I had lost one of the dearest people in my world. I'm feeling the same thing with my mother-in-law's possessions. I want to hold onto her a little longer. Perhaps this is less a goodbye than a new way to get to know her. Still, I do miss her.

Do unto others

I just popped over to visit The Agonist, one of the first blogs that I ever read with any dedication. The news stories on the front page seem to be covered well enough in the other blogs that I have been visiting, so I'm feeling no guilt at having outgrown the site. However, there is one item on the front page that caught my eye: an open thread to include folk's favorite adage or aphorism. I could not resist taking a look. There's a nice long posting of the wit and wisdom of Robert Heinlein, for one thing. And another is this long post contrasting statements about self-reliance/selfishness versus the Golden Rule theme.

The key statement in the post is:

And that is what you're really up against: many American leaders actually hold in esteem a belief system that explicitly refutes the collective moral reasoning of every documented human belief system except for white supremacy and Satanism.

The "adages" on self-reliance come from white supremacist writings, Satanist documents, and, that favorite of my youth, Ayn Rand. The statements can be summarized in the notion that the individual is responsible for himself and no other, having a duty only to himself.

In contrast, the poster (one Escher Sketch) provides a really long list of statements related to the "Ethic of Reciprocity," which we mostly know as the Golden Rule, from a really long list of religious belief systems (and a few philosophers). The list is so long that the ethic of reciprocity--do unto others as you would have them do unto you--almost seems like a cultural universal.

A couple of excerpts:

Ancient Egyptian:

"Do for one who may do for you, that you may cause him thus to do." The Tale of the Eloquent Peasant, 109 - 110 Translated by R.B. Parkinson. The original dates to 1970 to 1640 BCE and may be the earliest version ever written. 9

. . .

Socrates: "Do not do to others that which would anger you if others did it to you." (Greece; 5th century BCE)

The post provides a lot of evidence and sees little need to expound on the evidence, since the thoughtful reader can draw some immediate conclusions regarding the irony to be found in the philosophical underpinnings of a considerable amount of political action these days. Pedant that I am, I must hammer the point home--and point you back to the Agonist for the evidence.

And the point is this: Self-reliance is a good thing as long as there is a level playing field. If there is equal opportunity for everyone, and if everyone plays by the same rules without cheating, then it's fair to say that the individual should do his/her best to compete and succeed on that playing field. However, in order to have that level playing field along with equal opportunity and a consensus about the rules, there has to be an ethic of reciprocity first. There has to be respect for the other players on the field and a willingness to play fairly with them. Without that, we start looking as some really tacky rape and pillage that has nothing to do with the values that some folks say they live by but really don't.

[/end rant on hypocrisy]

Just a test

This is just a test to see how Blogger works with Hello. Of course, nothing is as simple as the marketing information says it is. Sigh. Right now, it's a matter of going from Picasa to Hello, post the picture, go find Blogger (not Bloggerbot) and edit the subsequent post. The Bloggerbot step is not working for me. Mayhap I should read the directions a bit more.


A Friend's Wedding

In any case, this picture shows the cake from a friend's wedding. It seemed cheerier than all the pictures of flowers from funerals that seem to be inhabiting my hard drive. No wonder I'm so depressed. I've been to a zillion funerals in past six months--and expect another one soon.

On naming streets

Off the Kuff provides a link at the bottom of a long analysis of the current discussion of state ways and means and school finance that seems almost a throwaway. While I grokked the essay on school finance and generally agree with Kuffner's analysis (i.e., this is screwy; it ain't enough; we'll be having the same discussion in four years, if not two), it's the "throwaway" that caught my attention.

Charles Soechting, Chairman of the Texas Democratic Party, has an essay about the current tug of war between two Texas legislators on what to name the drive around the Texas Capitol. That's the drive that is now blocked off with permanent and semi-permanent barricades--the road that no one drives on any more because no one can get to it. Soechting notes that the "choice" is between Ronald Reagan and George W. Bush.

For my own reasons, the thought of that little pissant piece of road being named after either Reagan or Bush is a problem. I don't, for example, fly into National Airport anymore since it was renamed after Reagan. I don't, if I can avoid it, fly into Houston Intercontinental Airport since it was renamed for GW's daddy (although I'm mellowing on that one). Aside from the more political reasons that have to do with their legacy, I am still way pissed that the Austin School Board refused to even consider naming a local high school for Barbara Jordan because she was still alive at the time. Instead they named the high school for that illustrious Texas hero, Jim Bowie, he of the big knife, many lovers, and much booze. Sauce for the goose, as they say.

But I digress. The road-that-no-one-can-drive-on is a small route around the capital building. It might even need a name so that it can be labelled on maps. Right now, it's just shown as one of the "Capitol Drives" with a label that says "No visitor access to Capitol Drives." (That should be "No visitor vehicles," since you can walk there, and legislators park there.) Whatever.

So Soechting makes a few points about why that little drive shouldn't be named for either Reagan or Bush (the younger):

If you feel that you must name something after the two of them, there must be some serious limits on where you do it. You certainly would not want to name a drive around the capitol after Reagan, simply because he’s not from Texas. And naming a road after George W. Bush is like naming a staircase after Gerald Ford, Bush’s record of drunk driving should dissuade anyone from naming even a private driveway after the man.

I love it! And there's more about the various other places that should not be named for these two men (no school for GWB because he was such a poor student, no banks for RR because he presided over the failure of so many of them). It's a good read, although I don't know that he offers any compromise names that will actually be attended to. One of them was Barbara Jordan, which, of course, I like, and which, of course, makes sense, since she started her political career in the Texas Senate (and that was the first political campaign I ever volunteered for). But that probably won't fly, so I hope the stalemate just hangs on until Sine Die.

Another road naming controversy has popped up over the naming of the stretch of I-20 between Dallas and Fort Worth. A couple of bills (HB 55 and SB 170) have been filed to name it for Ronald Reagan. Now that's a part of Texas where there is some support for naming things after Republican icons, but I do love it that Sen. Royce West (D-Dallas) is fighting back with a counter-proposal (SB 499) to name the same stretch of road for President William Jefferson Clinton.

Nobody is fighting over the re-naming of Hwy 290 in Harris County for Reagan (HB 540). Sigh. And I was just starting to like that as an alternate route to avoid all the congestion and construction on I-10. That definitely sucks canal water.

Bloggers not protected by Constitution

A quick search of newsmap popped up a disturbing story about an Apple suit against three blogs that revealed company secrets. The crux of the issue is whether blogs are "real press media" and whether they therefore deserve the same protection as print, radio, and television when reporting news and information.

A tentative ruling yesterday by Superior Court judge James Kleinberg is likely to have serious implications for the online publishing industry. In a preliminary ruling on a case filed by Apple Computer against three website publishers, the judge said Apple can force the three website publishers to surrender the names of their sources who disclosed confidential information about the company’s upcoming products.

. . .

By his preliminary ruling, judge Kleinberg had refused to extend to the Web sites the same protection that shields journalists from revealing their unidentified sources or surrendering unpublished material.

The Electronic Frontier Foundation argued their position that the web publishers are journalists and their sources are entitled to protection by the California Shield Law and the First Amendment of the U.S. Constitution. Both protect journalists from being forced to disclose their sources.

Apple’s attorney Riley countered by saying that free speech protection applied only to legitimate members of the press and not to website publishers. Freedom of the press was for the press, meaning the traditional media, he said.

The ruling for the case is expected next week and would determine whether those publishers will have to comply with the subpoena to turn over e-mail records and other documents relating to the leak.

I have a problem with the distinction between the need for protection by the first amendment for the press and the question of whether the press is participating in a criminal act. Cf. Robert Novak. I would think that the first amendment was not designed to shield criminal activity, whether it's part of industrial espionage or political machinations leading to a breach of federal law regarding revealing the names of spies. If the law is not clear on this, we are surely in trouble. Being a member of the "press" is not a license for criminal activity.

On the other hand, the whole argument about "real press" is a load of excrement. When the Constitution was written, there weren't any televisions. No radios. Few regular newspapers. There certainly wasn't an internet for Hamilton, Madison, or Jay to use to publish their ideas regarding the Constitution. But these media are merely vehicles, tools for an activity, not the activity itself.

When the intent of the activity is to provide news of events and persons, to analyze current events and ideas, there should be no doubt that it is the action of a "real press." Blogs fall into this category of "real press" when they break news, analyze events and ideas, push items of interest and concern to their respective communities, however small or dispersed.

The matter of Jim Gannon/James Guckert doesn't really muddy this distinction. Here is a fellow who wrote for an online news service, received press credentials for the White House, and actively labelled himself a journalist. He was (is), however, a political hack. How he got into the White House press briefings remains an important question. Whether his efforts were coordinated closely or even at some remove from White House officials is a legitimate question. That doesn't take away from the role that he was filling--however poorly--of an internet-based reporter.

Gannon/Guckert got notice and then trouble because of his blatant partisanship. The underlying implications behind this trouble included an assumption that he was acting as a member of the legitimate press, albeit internet-based, and failed to live up to the standards of good journalism. He didn't write original stories; instead he paraphrased official press releases. He used his access to the White House to propagandize a particular point of view. He played the role of journalist without fulfilling the responsibilities of a journalist.

The same, sadly, can be said of far too many journalists in the "real press." But the medium that they use to present their reports is not the same as the reports that they are presenting.

There is a distinction between the news that one gets in the print press and in the television press. Television looks for visuals. The stories are usually brief and presented as if there were some drama involved. The print press looks at stories in more detail, has more space and time for examination of the underlying problem. The internet-based press, including blogs, often reviews stories presented in other media and expands on them or places them in a more well-defined context. Sometimes the internet-based press reports new details of current stories or even breaks entirely new stories.

By the same token, the internet-based press comes under fire for its adherence--or lack thereof--to current journalistic standards. It is entirely legitimate to expect of the blogs that one reads that the writer(s) make their biases clear and state any conflicts of interest that they may have on an issue. It is entirely legitimate to expect that any facts reported be substantiated with sources.

Why am I so het up about this? I have waffled around with Canal Water Review. Sometimes I have posted personal stories, especially about things and people that have affected me deeply. More often, I have posted my responses and analyses of issues that have been reported elsewhere, sometimes in obscure sources. I haven't decided the degree to which this blog is more political than personal, although it seems to be trending that way these days.

But I have another blog. It's professional. It focuses on a particular issue--and breaks news. It is intended for a particular audience and directed toward getting news about the issue to that audience. Sometimes I get information from sources that would not want to be revealed. I got a memo the other day which had been sent to a committee. I am not a member of that committee. The person who sent it to me is not a member of that committee. Yet, the information should have been public information. It just happens that the person who wrote it is a state employee and cannot circulate such information on his/her own account beyond the bounds of the committee. Luckily, I got it third hand (I got the original, but it came through several hands). I cannot really see anyone every questioning my having that memo or demanding my source, but, in the crazy event that should that happen, you damn betcha, I'm going to claim that that blog is "real press" and that the first amendment applies.