Friggin' Liberal Doctors!

[drgrant]

I'm actually comfortable with the thesis that access to guns increases suicide rates.

I'm not, and I think it's a completely bogus argument.

The general population in Japan have little or no access to firearms and it has one of the highest per-capita suicide rates in the world.

If people really want to take their life, they will do it. A gun might be the first thing they use if it is around, but do you really think that someone actually wants to kill themselves is going to be stopped by not having a gun?

I'll give you a more domestic example.... an awful lot of these kids who commit suicide because they were bullied, do so by hanging themselves. Taking one's own life is not rocket science. I see an awful lot of these bullied kids hanging themselves at home, maybe the docs should be saying that they had access to extension cords... yeah that's the ticket...

-Mike

 

[M1911]

It seems as if any perceived "negative" about guns leads to outraged threads on NES. Recently, I considered responding to a few threads about criminals caught by police with guns where people responded with support for the criminal. This current thread is another one where, as responsible gun owners, we should be informed and aware of the risks and negatives of gun ownership. If we ignore these completely, we may lose credibility for more important stances on issues.

Physicians should ask about gun ownership, just as they should ask about seat belt usage and other issues. There have been many, many well done studies approaching this from many different directions and published in prestigious journals that demonstrate a very significant - 2-5 fold increase - in suicides in homes where guns are readily available. Depression is a very real issue for a substantial percentage of society, and thoughts of suicide are quite common. Of all the methods of suicide, guns are both rapid and effective. Suicidal thinking often passes or can be managed, but not if someone has already acted on the impulse. Before arguing with the points I have made, I suggest you read a relatively recent editorial in the NEJM - arguably the most influential medical journal in the world: http://www.nejm.org/doi/full/10.1056/NEJMp0805923

This is not about liberal doctors. It is about good doctors, doing their job properly. The responses to such a questionnaire aren't going to go in some "big brother" database. They are going to help guide your physician when he/she might wonder about depression or suicide risk.

BS.

Let's look at some accidental death statistics from 2009:

accidental discharge of firearms: 554
falls: 24,792
drowning: 3517
poisoning: 31,758

Doctors ask about firearms, but don't ask about falling, drowning, or poisoning risks, even though they account for about 1000 times more deaths than firearms accidents.

It is all political and any assertion otherwise is, to be polite,

 

[DrRansom]

It was published in a respected, peer-reviewed journal.

That doesn't mean much. Anyone who's spent time in academia knows some pretty crappy stuff slides through constantly, and rarely do the reviewers question the data - and very, _very_ rarely do they actually set up more examples to prove it out.

 

[Sterg]

He could have been worried about inappropriate questioning (I wonder of docs are trained to get kids alone for just this reason) rather than molestation.

But, by 15, a kid should know how to handle a medical interrogation. Actually, the kid should have an FID at that time, thus enabling the answer "Our big brother considers it OK for me to have access to the fifty cal dad keep in case of an elephant stampede".

True. You have a good point.

 

[DrRansom]

It is the responsibility of physicians under law, and it is no different than your responsibility as a citizen to report certain crimes, even if committed by a friend. Does that make you a snitch or co-mingle your responsibility as a friend with law enforcement?

See something, say something, that's what I always say.

 

[cekim]

That doesn't mean much. Anyone who's spent time in academia knows some pretty crappy stuff slides through constantly, and rarely do the reviewers question the data - and very, _very_ rarely do they actually set up more examples to prove it out.

"Peer review" by itself is not really what moves something from theory/agenda/BS to good science. It requires the passage of time, the injection of new scientists looking at things, the shift of agendas and motives to provide perspective.

This is the fundamental failing of progressive science and governance lately (by lately, I mean the last 100 or so years) - they take something from theory to law after only "peer review" without allowing the passage of time to leave its mark.

Even where it isn't blatantly agenda driven BS, it is bad science masquerading as good. It just isn't ripe and should not be used for legislation (ever, but certainly not so soon). As much of a scientific minded person as I am, the application of science to sociology and politics has done at least as much harm as good in the past 100 years.

It's first big outing was eugenics and we see how that ended up (I say ended, but progressives are bringing it back in many ways with new words to paper over the old ideas of centrally managed economies and societies). They are trying to re-sell the same ideas again, but you can still smell the bleach they bathed in to get the blood stains off.

 

[M1911]

Speaking of well-respected, peer-reviewed journals, a lot of crap still makes it into them. A few years back I attended a lecture given by a med school professor (I think he was from Duke, but I can't remember his name). He described a journal article where the authors claimed to have found an effective marker in blood for the presence of prostate cancer. As you probably know, the PSA test is unreliable, so a reliable marker for prostate cancer that does not require a biopsy would be a really important find.

So this professor contacted the original authors to get the data and look into it more closely. It was a cancer versus normal gene expression study. But it had a bit of a problem. The members of the cancer cohort were, as you might expect, older (~50 or 60 IIRC). The average member of the normal cohort was a 37-year-old woman.

Now, I'm a software guy, not a biologist, but even I know that women don't have prostate glands, so including women in the normal cohort completely invalidated the study. And the difference in ages between the cohorts likely also introduced another confounding factor. But it still made it into a top name, peer-reviewed journal.

And this isn't all that unusual. Amgen recently tried to reproduce the findings of 53 landmark cancer research papers. They were only able to reproduce the results of 6. In other words, the results of 89% of the papers could not be reproduced. http://www.nature.com/nature/journal/v483/n7391/full/483531a.html

 

[endus]

**** do I care if my doctor knows I own guns. I'd just answer yes and move on with my day. I don't hide the fact that I'm a gun owner.

 

[Rob Boudrie]

They were only able to reproduce the results of 6. In other words, the results of 89% of the papers could not be reproduced.

That's what the Journal of Irreproducible Results (www.jir.com) is for.

 

[bender73]

I don't think you understand the depths of contempt and disgust in which many people - gun owners especially - are holding the current state of our society and government. You are trying to use the mechanics and legalities of the machine as an excuse. I understand you are "obligated" to do it - but that is the part that makes it all so onerous and tyrannical.

This is one of the BEST posts I have seen in this forum, and really nails it in this thread.

I was letting myself air out and cool down (as well as others who I am sure dislike me by now) before taking a look again. And I will work on my grammar just for this thread. LOL.

I think that is the issue. I see a ton of anger here and I am not saying that you guys are wrong for being disgusted with the GOV. I am also angry to a point, but I guess I don't feel as much contempt for our society. I am certainly not some rich snob with all this power. Not at all. My character has been attacked by some and I don't think it was accurate or justified. But, that's ok. My obligation to a one single patient, viewed as a sum total, affects many people, or society. So, I look at things a little different. Right or wrong, it is who I am. It does not change my anger towards many issues in GOV, but I do feel a certain amount of responsibility when an issue like this occurs. Also, many here may not agree with me, or the medical establishment. But, there are many others that look to the medical community for help, safety, etc. Maybe not you, but one must view things from both perspectives. I deal with every walk of life 40-50hrs a week x 10+ years. I like to think that I have reached the point where I keep a very open mind. I can see your anger. More then one time here I have tried to explain the reasoning behind a gun question. A lot here feel it is none of our business. Well, maybe you're correct. Maybe not. The beauty is, you do NOT have to answer. If you did not answer me, I would move on. It would not affect the way I care for you at all. I would not look at you like some "gun nut." I would see a person that values their freedom and privacy. Sure, I want to know as much as I can because in the end, it helps me to know a person as a whole and not just a robotic approach to a generic human's organ structure.

I dunno, maybe this post sheds some more light on me. Maybe you will understand that most Docs and Nurses could care less about the GOV, questions, etc., especially when in the midst of caring for someone in need. When I am with someone that seems mentally unstable, dangerous, or scared; I am completely there for them. I am 100% in the moment and my only thought is to do what I can to help them. If they don't want my help then I respect that. But, if they are clearly a danger to others then I do not care what anyone says, they will be detained. I say "clearly a danger," as in threats and not of sound mind. Acting dangerous and insane.

I don't know of any provider I have ever worked with who would do anything to interfere with one's life, privacy, or freedom unless there was some situation that was so grave that most people would say, "duh" anyway. I know I don't want to take your guns. Sh!t, i just want my damn LTC! (still waiting). Maybe there is a larger issue. Maybe I am just a little fish in a big ocean. But, I am doing my part to help and I truly feel good about what I do and how I do it. I don't look at it as serving a tyrannical GOV. I look at it as serving my fellow man (corny, I know).

 

[KDeez]

I would see a person that values their freedom and privacy.

the REALITY is that we, as a society, decide who has rights.
serious mental illness HAS TO BE DETERMINED. it is that simple. i am not saying i have the answer, in fact, i have said that many times up to this point.

But, if they are clearly a danger to others then I do not care what anyone says, they will be detained.

Couple questions if you wouldn't mind answering :

1. So you admit you don't have the answer, yet you make that call to detain someone, and you'll infringe on someone's rights based on nothing more than the mere thought that they may commit a crime?

2. How can you say you see a person that values their freedom and privacy, yet feel you have the right to deny and "decide" someone elses right based on pure speculation?


- Just pointing out you have a lot of conflicting statements on this. Some of the things you're saying are a little troubling. This is why you may feel others dislike you and are angry.

 

[bullseye]

Couple questions if you wouldn't mind answering :

1. So you admit you don't have the answer, yet you make that call to detain someone, and you'll infringe on someone's rights based on nothing more than the mere thought that they may commit a crime?

2. How can you say you see a person that values their freedom and privacy, yet feel you have the right to deny and "decide" someone elses right based on pure speculation?


- Just pointing out you have a lot of conflicting statements on this. Some of the things you're saying are a little troubling. This is why you may feel others dislike you and are angry.

Just out of curiosity, have you ever been in an ER when a person is brought in completely delusional and an obvious threat to one's self, never mind the people around him/her. It's a call that if the Dr. doesn't make and results in someone getting injured or worse as a result of not detaining for observation or treatment, the attending physician may be legally responsible for. I'm not referring to someone who walks in and thinks Yogi Bear is talking to them, some folks have completely lost it and are an emotional mess and are completely unaware of the danger they pose to society. Dilemma, the shooter in Aurora CO. was under a Dr.s care for mental issues, he cracked and was not obvious, but had all the signs. The Dr. did take further action by contacting university police who sat on it. She now has to live with that decision not to commit as well as the police, who failed to act.
It's a tough call with no easy answers.

 

[M1911]

Just out of curiosity, have you ever been in an ER when a person is brought in completely delusional and an obvious threat to one's self, never mind the people around him/her.

In most states, it is almost impossible to get a doctor to involuntarily commit someone, particularly if they don't have health insurance. I have a relative who is schizophrenic and tried to commit suicide. She almost succeeded. They cut her loose after a few days in the hospital.

The psychiatric profession has a terrible history of abusive treatment and involuntary confinement of people who don't need to be confined. As a result of that, we've gone to the other extreme, and therefore people who really are dangerous don't get the treatment that they need.

 

[Rob Boudrie]

They cut her loose after a few days in the hospital.

I think it's fairly easy to get someone committed for a few days of observation ("Pink slipping"), but hard to get them committed on a longer term basis.

The psychiatric profession has a terrible history of abusive treatment and involuntary confinement of people who don't need to be confined.

There have been cases of facilities pushing involuntary confinement of minors (where all that is required is convincing the parents its necessary) which would just happen to last about as long as their insurance limit for such treatment.

 

[M1911]

I think it's fairly easy to get someone committed for a few days of observation ("Pink slipping"), but hard to get them committed on a longer term basis.

It isn't in Illinois.

 

[Rob Boudrie]

It isn't in Illinois.

I should have mentioned I was talking about MA.

 

[M1911]

I should have mentioned I was talking about MA.

It is my impression that it isn't very easy in MA either.

 

[bender73]

Not a tough call at all. Easy answer is this: Do not detain or commit someone because you think they might do something bad. It's really no different than the pre-crime BS that DHS is testing out.

James Holmes did something awful. However, right up until he pulled the trigger, he deserved all the same freedoms that we are trying to keep the .gov from stripping away. Including the right to own whatever guns he wanted, and the right to choose how he would use them.

you are correct. This is where I think people are taking what I said too far. If that guy was just depressed or weird, then there was no right to detain him or do anything. Nobody is saying one's personality or even anxiety/depression is a clear predictor all the time. This is not the movie Minority Report with Pre-crime or something. But, if he expressed a strong desire verbally to do what he did, and showed neuro-psychological signs or symptoms, then detainment is justified for public safety. A lot of you have probably never seen or engaged with a person that is truly psychotic, or in the throws of such an episode. They can be very scary, angry, and delusional to the point where you actually feel threatened just by being in their company.

 

[Terminator03]

you are correct. This is where I think people are taking what I said too far. If that guy was just depressed or weird, then there was no right to detain him or do anything. Nobody is saying one's personality or even anxiety/depression is a clear predictor all the time. This is not the movie Minority Report with Pre-crime or something. But, if he expressed a strong desire verbally to do what he did, and showed neuro-psychological signs or symptoms, then detainment is justified for public safety. A lot of you have probably never seen or engaged with a person that is truly psychotic, or in the throws of such an episode. They can be very scary, angry, and delusional to the point where you actually feel threatened just by being in their company.

For some reason a few here still are not comprehending what you are trying to say for some reason. I understand your intention completely now, thanks for sticking around to explain your position further. It is pretty simple, especially when you point out the "Minority Report" reference. You are not in the business of reporting someone, or putting them in a position to risk losing their rights until they show such extreme behavior that most lay people would be able to clearly see what you were seeing. I just don't get why it's so hard for some here to grasp?

 

[Terminator03]

This is the very reason we have a constitutional republic and not a democracy. It doesn't matter what most lay people think is extreme behavior. If a person is hurting themselves, it is no one else's business. If they are not hurting someone else, destroying or stealing someone else's property, or impeding someone else who is trying to exercise their rights, it is no one's business.

I don't care if someone is considered batshit crazy by the medical profession or "most lay people". If they are not doing anything that infringes on another person's right to life, liberty, or property, then it isn't for anyone else to restrict or attempt to restrict their rights. Do I want people I consider bastshit crazy to have a gun? No. But it isn't my choice to keep them from having one.

Liberty is usually uncomfortable, oftentimes painful, and sometimes downright tragic in its practice - but I will take that over one iota of intrusion from a power-hungry minority in government.

Not disagreeing with what you are saying here, but in the situations that bender pointed out, he was stating that it would be a situation like one of those "batshit crazy" guys you mention stating they were going to kill, or hurt someone else. In that case it is very clear that as an MD, or even just a decent citizen, you have a moral imperative to intervene in most cases. Where the line gets blurred (inmo) is when someone speaks of self harm. In that situation, I agree with you that it is none of anyone's business in a "free" society, but an MD (or other mandated reporter) doesn't always have the luxury to "look the other way".

 

[bender73]

If there was a threat, then it would be appropriate to investigate. However, expressing a strong desire to do something is not a threat. It is protected speech. There are many things said on NES, in music, on blogs, etc. that express a strong desire to do things that some may consider threats, but they are not.

There is a big difference between actually saying you are going to kill a bunch of innocent people at the movies, and merely saying something like, "You know, sometimes I just want to walk into a crowded theater and start blasting people!"

If saying the latter gets someone on a list and gets their rights restricted, we are all in trouble. LOL

You disagreed with me first, but you seem to agree here. I did say initially that someone would have to be a danger to others. I was clear that they would have to show neuropsychological signs of delusions or psychotic behavior. Every sane person says whacky things at times.

 

[M1911]

The thing is, most psychiatrists will admit that they can not accurately predict who will or who will not be violent. This whole discussion assumes that doctors can accurately predict who is a danger to themselves or others, and thus start process to deprive them of their liberty. But they can't, so the result is that some people who aren't dangerous are incarcerated and others who are dangerous are not.

 

[cekim]

The thing is, most psychiatrists will admit that they can not accurately predict who will or who will not be violent. This whole discussion assumes that doctors can accurately predict who is a danger to themselves or others, and thus start process to deprive them of their liberty. But they can't, so the result is that some people who aren't dangerous are incarcerated and others who are dangerous are not.

Yes, using larger words does not mask the inherent subjective nature of the assessment. Which is where due process comes in.

It is a tough and painful problem to solve (because true respect for privacy and confidentiality may very well result in isolated incidents of "preventable" violence), but we have swung quite far in the wrong direction as demonstrated with recent events in Virginia and many past examples in MA and around the country. Even more extreme examples can be found in relatively recent history of communist/socialist regimes, where it was common belief that failure to accept the virtue, rule and wisdom of "the party" was clearly a sign of mental illness in a very clinical (to them) sense.

 

[bender73]

No, you have gone too far again. We are NOT predicting future violence of some people. We are talking about a moment in time. A person in a psychotic episode. This is a very important point. This is a person displaying signs of being an imminent threat. I will repeat, if you have never been in the presence of someone truly psychotic and dangerous then you may not understand the need to intervene.

It is not about the average person that may be depressed.

 

[M1911]

It's just not worth it. You simply won't ever get it.

 

[bender73]

It's just not worth it. You simply won't ever get it.

...and I will say the exact same thing to you.

 

[cekim]

No, you have gone too far again. We are NOT predicting future violence of some people. We are talking about a moment in time. A person in a psychotic episode. This is a very important point. This is a person displaying signs of being an imminent threat. I will repeat, if you have never been in the presence of someone truly psychotic and dangerous then you may not understand the need to intervene.

It is not about the average person that may be depressed.

Sigh... I haven't worn the scrubs so I can't comment?

Actually, I have witnessed this in person, which is why I said it is a tough and painful problem to solve as a society and much as I have experienced violent crime, yet I still advocate for error on the side of liberty, I say we must do the same in medicine - even when it hurts.

Again, you assume that I am attacking the entire profession and everyone in it because I/we are discussing a failure mode(s) of our present system in the context of history which shows that the structure of our system is progressing towards systems that have failed spectacularly in the past - the the point of being a front-line weapon against freedom of expression, freedom itself and ultimately a mechanized tool of genocide.

Of all the 10's of millions of people being treated in this nation, we are talking about a tiny fraction of a fraction of a fraction who are suffering abuse from the problems I am pointing out. The trouble is that as a matter of principle, that is still too many.

The same principle of "the guilty may go free so that the innocent are not convicted" must apply to medicine as well.

I am not saying there are not good DRs, I am not even saying that MOST DRs aren't doing a good job. I have now said repeatedly, I have not personally been treated by a physician I felt I could not trust or violated that trust, but I have most certainly read about such abuses here in the US and throughout history.

What I am saying is that the medical and legal worlds have been deeply co-mingled out of fear and the general Nanny-State mentality.

Further, IMUO there has been a more general cultural/social shift towards an unrealistic expectation of what the range of "normal human emotion" really is. We can see examples of that in the schools with over medication of kids and then on into adulthood with over medication of adults.

A powerful central government, weak protections of privacy amongst "gate-keeper" professions, weak protections of civil liberties and lots of debt is a nasty cocktail that has been seen before. All you seem to be willing to promise is that you will be a benevolent dictator. Not good enough.

 

[KDeez]

Every sane person says whacky things at times.

...

the REALITY is that we, as a society, decide who has rights.

.

 

[bender73]

Most doctors are not doing a good job? Pulling little pieces of what I say to quote me in a manner that does not tell the whole story within the proper context? Thinking it is ok for a truly insane person to walk away after a direct threat, maybe on some innocent child? Good grief people. This is scary.

 

[cekim]

Most doctors are not doing a good job? Pulling little pieces of what I say to quote me in a manner that does not tell the whole story within the proper context? Thinking it is ok for a truly insane person to walk away after a direct threat, maybe on some innocent child? Good grief people. This is scary.

Reading comprehension issues (yours) - I said I was NOT saying most DRs are not doing a good job. I repeatedly indicated to the contrary - most ARE doing a good job. This is not about what most DRs are doing, it is about how the system is structured and its potential (and actual) abuse.

...are you really going to roll out "for the children?" [sad2]

Sarah Brady called, she wants her histrionics back.