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My PA program was the Army. We were woke at 5:30 for PT. That was about as woke as we got.

Unfortunately patients are real people and things like climate change, race, sexual orientation, immigration do affect the medical issues we may encounter when providing their care. Do I think medica

I talk to my homeless patient about his homelessness.  I've had a number of my patients forced to move against their will, if not outright evicted, over the years. I talk to my minority patients about

12 minutes ago, Boatswain2PA said:

How so? 

As an Army graduate of IPAP with friends still in the program and a coworker who just graduated, I can assure you that there is no required rotation through an LGBTQ clinic. How on earth could you believe this?

I have never even seen a “LGBTQ practice” on a base. Never heard of it. What base was this on? At what MTF and in what department?

There may be a single lecture or presentation about some of these issues but that would be the most of it.

 

Also, what kind of an asshole would leave a job educating people that will be serving in war zones overseas because of some LGBTQ education?  “I would love to help the troops but now that they allow those types in, I quit!”

 

 

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1 hour ago, thatgirlonabike said:

That's fine for the catch and release aspect of the ED.  But in primary care you CAN'T treat the homeless hooker, like the abused kid, like the underserved housewife like the football player.  And if you don't have some understanding of the social determinants of health care you will fail as a provider.  

Well, somehow I DO treat these people in primary care and have been taking care of all comers for nearly 30 years. Zero to do with ER work. 

I have pretty insightful knowledge of social issues and deal with them daily and quite well. Homeless, harsh mental health issues, military sexual trauma, transgender and LGBTQ veterans and women’s health to boot. 

So, not really getting your point. 

Treat the patient - respect the circumstances - do no harm and do your best.

Kinda the Golden Rule of Medicine

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29 minutes ago, PAMEDIC said:

As an Army graduate of IPAP with friends still in the program and a coworker who just graduated, I can assure you that there is no required rotation through an LGBTQ clinic. How on earth could you believe this?

I have never even seen a “LGBTQ practice” on a base. Never heard of it. What base was this on? At what MTF and in what department?

There may be a single lecture or presentation about some of these issues but that would be the most of it.

 

Also, what kind of an asshole would leave a job educating people that will be serving in war zones overseas because of some LGBTQ education?  “I would love to help the troops but now that they allow those types in, I quit!”

 

 

Good to know.  

I inferred from our conversation that it was a full rotation, and assumed it (and most) rotations are off-base.  He told me that it was required because of the Obama-era accepting of transgender into military.

And if I remember right, he didnt "quit", he retired.

I could certainly see the military summarily requiring something like this.  Lots of people make O-6 by pushing knee-jerk reactions to small political issues.

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36 minutes ago, turnedintoamartian said:

These issues have an impact on health and have a place in medical education. This reads heavily like a “get off my lawn” or “old man yells at clouds” type of situation. 

I read the article more about there being a growing imbalance in medical school education.  I dont think anyone would disagree with lectures about social determinants of health, but the focus of medical education should be....medicine.

As another example, history of medicine is also important so we can see how many times we got things wrong, who got it right, and why we do what we do.  Galen doing post-mortem dissections was against the rules, but he got around it by using gladiators, thus learning anatomy offers medical students a great story about resilience, etc.  But education in medical history should not come at the expense of time learning medicine.

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8 hours ago, JoeM said:

If you don’t think climate change is going to affect people’s health I think you will be in for a rude awakening

Have you, or anyone else, seen a patient who has had a health condition that could be directly linked to climate change?

I dont think I have.  But as I'm typing this I am getting ready to go look for that armadillo who is tearing up my yard.  When I was a kid they didnt come up this far....

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Have you, or anyone else, seen a patient who has had a health condition that could be directly linked to climate change?
I dont think I have.  But as I'm typing this I am getting ready to go look for that armadillo who is tearing up my yard.  When I was a kid they didnt come up this far....
Have you seen the movie Geostorm? Lol

Yeah, we can't do anything close to the need to help climate change besides creating tech to stabilize the weather. Stopping carbon emissions (even though it is definitely contributing) is a joke to think it will help. That stance is just lobbied by people trying to make money in the green sector. Climate stabilization tech is where its at. Climate change is overblown though, people act like we just stop drilling oil and driving gas cars it will magically go away?[emoji848]

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3 hours ago, Boatswain2PA said:

Have you, or anyone else, seen a patient who has had a health condition that could be directly linked to climate change?

I dont think I have.  But as I'm typing this I am getting ready to go look for that armadillo who is tearing up my yard.  When I was a kid they didnt come up this far....

Increasing temperatures with high humidity (increasing air density) will assuredly affect COPDers for example. 

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We had to go through a forced (do it or you dont graduate) diversity course, AND a group diversity "immersion experience" that involved living a mock lifestyle of someone else for a day, AND had to sit through a mandatory "gay day", where people of various LGBTQ persuasions came in and talked to us about their lives and how we can treat them better. 

Listen , I seriously could not care any less about my patient's sexual/gender orientation unless it is somehow pertinent to the clinical scenario, nor do I need to be force-fed all this propaganda to know that you should treat all of your patients as equal human beings. 99.99% of all providers do not need to be taught this, at least in their formative years. 

 

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I'm sure we can all find some anecdotal experience relating to over the top diversity training or the other end of the spectrum. 

What I fail to see though is any evidence that the physicians being put out today are any less qualified than those from 30 years prior.  I'd argue that if anything they are coming out with more knowledge and a better ability to access that knowledge. 

And yes, working in pulm I can see a relationship between increased pollution, wildfires, weather pattern changes and the effect on patient's health and well being. 

Seems like a straw-man argument for what the author believes is a decline in the quality of medical proficiency over the years.

 

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We had a speaker tellong us how to do abortion and joeseff asked if the ever survived the abortion, then he said, "sometimes but then we just give them a shot of methotrexate they stop breathing." Joeseff ended up saying, "this is bull@@##." Then he walked out. A few minutes later I did too. I am just appalled when we try to save a brain dead old person but when a fetus starts growing the brain and spinal cord the 1st trimester I for one am against it and would rather not partake in the festivities. Then my coordinator still tried to set me up with Planned Parenthood. I told them to kick me out if it means so much for me to be at planned parenthood which promotes optional abortions. Then they pulled another OB out of their butts to place me.

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I was trained in Ohio.  The PA practice laws there specifically forbid a PA from performing or assisting in abortion and also from prescribing any medication for the purposes of inducing an abortion.

I spent a large portion of my life in corporate American before becoming a PA.  In the 1980's we had lots of diversity training.  In those days the focus was on gender and race issues.  I saw one "world" in my colleagues in corporate American and an an entirely different "world" in many of the the people I encountered who needed the services of the fire departments I belonged to.  My take was that I had much more in common with my corporate co-workers in terms of lifestyle, goals, aspirations for our children, etc. even if we were of different race, gender, religion, sexual orientation, etc, that with many of the folks I made runs on even if they were of the same race, gender, sexual orientation, etc.  It seemed to me that similarities in economic situation dwarf other differences, probably because of education, goals, etc.  Many of our trainers weren't interested in that perspective.

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On 9/16/2019 at 11:42 PM, Boatswain2PA said:

What kind of evidence could be shown?  How about the growth of M.Ed (or PhD.Ed) as administrative staff at medical schools?  I dont know if he is right, but could be objectively measured.

Seems pretty easy to me; attach some curriculum's; show me the overwhelming shift to "climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness". Otherwise, this is just sensationalism.

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Seems pretty easy to me; attach some curriculum's; show me the overwhelming shift to "climate change, social inequities, gun violence, bias and other progressive causes only tangentially related to treating illness". Otherwise, this is just sensationalism.
I think what he means is when the administration comments on progressive leftist ideas. I had an ER group president say as a company, we believe rifles should be taken off the streets and us as ER providers see the repercussions. I thought thats not his role and half the company probably doesn't agree with your position.

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I think what he means is when the administration comments on progressive leftist ideas. I had an ER group president say as a company, we believe rifles should be taken off the streets and us as ER providers see the repercussions. I thought thats not his role and half the company probably doesn't agree with your position.

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But on the flip side i dont think an medical provider should not call a man a women's name if thats what they prefer. With the exception of actually preforming abortions, political and religious stances should not interject a patient provider relationship.

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This is a nice wide ranging discussion. We've got climate change, preferred pronouns, abortion... and it's all been fairly non-combative thus far. Well done! I read the original article earlier this week or last when it came out. I read it as the author becoming increasingly tired of the social issues having a bigger piece of the educational pie in med school. Reading between the lines, he also disagrees with anyone other than MD stipulating educational goals in med school, thus his rants against educational doctorates driving the model. Can't say I disagree. 

 

I view a persons sexual preference as irrelevant unless it impacts their complaint (ie rectal foreign body..). Frankly, those that wear their sexual preferences on their sleeve are quite annoying. We had a 2+ hour class in residency at Iowa on LGBTQ stuff. They discussed preferred pronouns, advocates, clinics specifically for these issues etc. Not being originally from Iowa, I was surprised at the seeming prevalence of alternative lifestyles. I soon realized that's mostly confined to around Univ. of Iowa, Iowa City and the University hospital. While I don't personally agree with the lifestyle of any of those letters, I did find it useful to have been exposed to that education and way of thinking. My personal feelings don't affect the care I provide and we should all treat each others a good humans anyway.

 

That being said, I'm still trying to understand how seeing yourself/identifying as a different sex isn't a psych issue. I've had numerous psych pt's commited for less in my ED... Perhaps this is a manifestation of some other emotional trauma or just a call for attention. I know this is a touchy issue for some and can be difficult to discuss. 

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1 hour ago, JMann said:

This is a nice wide ranging discussion. We've got climate change, preferred pronouns, abortion... and it's all been fairly non-combative thus far. Well done! I read the original article earlier this week or last when it came out. I read it as the author becoming increasingly tired of the social issues having a bigger piece of the educational pie in med school. Reading between the lines, he also disagrees with anyone other than MD stipulating educational goals in med school, thus his rants against educational doctorates driving the model. Can't say I disagree. 

 

I view a persons sexual preference as irrelevant unless it impacts their complaint (ie rectal foreign body..). Frankly, those that wear their sexual preferences on their sleeve are quite annoying. We had a 2+ hour class in residency at Iowa on LGBTQ stuff. They discussed preferred pronouns, advocates, clinics specifically for these issues etc. Not being originally from Iowa, I was surprised at the seeming prevalence of alternative lifestyles. I soon realized that's mostly confined to around Univ. of Iowa, Iowa City and the University hospital. While I don't personally agree with the lifestyle of any of those letters, I did find it useful to have been exposed to that education and way of thinking. My personal feelings don't affect the care I provide and we should all treat each others a good humans anyway.

 

That being said, I'm still trying to understand how seeing yourself/identifying as a different sex isn't a psych issue. I've had numerous psych pt's commited for less in my ED... Perhaps this is a manifestation of some other emotional trauma or just a call for attention. I know this is a touchy issue for some and can be difficult to discuss. 

It is a psych issue; it's called gender dysphoria. Research shows that it's more beneficial/mentally healthy to let them assume their preferred/identified gender, rather than confining them to their biological gender.

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