What we’ve learned about Ebola

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As a physician and a public health advocate, you would think I’d have plenty to write about the Ebola outbreak.  To be honest, the whole situation has left me rather uninspired, mainly due to the ridiculous hysteria surrounding the disease in the US media.  That said, the current outbreak has made some things particularly clear.

  1. Americans don’t care about events in other parts of the world… until it affects our own borders.
  2. Americans are terribly uneducated in geography.
  3. In a battle between science and fear/hysteria, science will always lose.
  4. Any issue, no matter how apolitical, can be turned into a political weapon… by both parties.
  5. Our country continues to misfear.
  6. We expect our health care system to save us in times of crisis despite complaining about it constantly.
  7. We underestimate the importance of public health (see number 6).
  8. Only one person in the United States has died from Ebola, and only one person is currently under treatment.
  9. There have already been deaths from the flu this season, including a child who died this week.

Fearbola in New York City

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News that Dr Craig Spencer was diagnosed with Ebola in New York City spread quickly last night in the media.  I’m confident that the residents of NYC will handle this in stride, after all they’ve dealt with worse in the past.  But just in case, here’s a reminder not to panic.

(For the record, I cannot take credit for this image.)

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Another marriage equality win – in Wyoming

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U.S. District Court Judge Scott Skavdahl ruled today against Wyoming’s law banning marriage equality for same-sex couples.  Judge Skavdahl granted a temporary stay and the ruling will not go into effect until October 23 or until state government officials say they are not appealing the decision. In his ruling, Judge Skavdahl wrote, “The court understands that every day where same-sex couples are denied their constitutional rights is another day filled with irreparable harm.”

Wyoming’s Governor Matt Meade has previously said that the state should not appeal the district court’s decision if the ban is struck down.

Judge Skavdahl’s ruling came hours after a similar ruling in Arizona, although the judge in Arizona refused to issue a stay.  If Governor Meade’s statement is any indication, marriage equality will be swiftly coming to Wyoming.

Wyoming Marriage Equality Win

Marriage Equality in the Grand Canyon

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Today, October 17, U.S. District Court Judge John Sedgwick ruled in favor of the freedom to marry in Arizona in a federal legal case that challenged the state’s anti-marriage constitutional amendment.

Judge Sedgwick also refused to place a stay on his decision, meaning marriages could begin almost immediately.

Arizona geographically falls under the U.S. Court of Appeals for the 9th Circuit, which recently ruled in favor of mariage equality in both Idaho and Nevada.  Arizona’s Attorney General has said that he will decide on Monday, October 20 whether or not he will appeal the ruling.  Given the 9th Circuit’s prior rulings, it is highly unlikely that any appeal would be successful.

ArizonaRuling marriage equality

seriously people…

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Marriage equality marches forward

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While I was away for the long weekend, several key victories occurred for marriage equality.  In case you missed them as well – a quick little wrap up for you.

North Carolina – On Friday, October 10, a federal judge in North Carolina agreed that the ruling in favor of the freedom to marry in the 4th Circuit also applies to North Carolina’s state constitutional Amendment 1, which bans same-sex couples from marrying.  In the ruling, Judge Cogburn wrote:

The issue before this court is neither a political issue nor a moral issue. It is a legal issue and it is clear as a matter of what is now settled law in the Fourth Circuit that North Carolina laws prohibiting same sex marriage, refusing to recognize same sex marriages originating elsewhere, and/or threating to penalize those who would solemnize such marriages, are unconstitutional.

Same-sex couples were immediately issued marriage licenses on Friday.

Alaska -  On Sunday evening, a federal judge struck down Alaska’s ban on same-sex marriage.

The U.S. District Court for the District of Alaska ruled that the state’s ban was unconstitutional under the Due Process and Equal Protection Clauses of the U.S. Constitution.  U.S. District Judge Timothy M. Burgess wrote that any relationship between the ban and government interests was “either nonexistent or purely speculative.”  In the ruling, he states,

Alaska’s same-sex marriage laws are a prime example of how ‘the varying treatment of different groups or persons is so unrelated to the achievement of any combination of legitimate purposes that we can only conclude that the legislature’s actions were irrational.  [...] Refusing the rights and responsibilities afforded by legal marriage sends the public a government-sponsored message that same-sex couples and their familial relationships do not warrant the status, benefits, and dignity given to couples of the opposite sex.

Alaska’s governor has already announced plans to appeal the ruling to the 9th U.S. Circuit Court of Appeals, although that court ruled against similar bans in Nevada and Idaho.  You can already hear Sarah Palin having a coronary.

Idaho - The 9th Circuit Court of Appeals has dissolved the stay blocking same-sex marriage in Idaho, announcing that couples may begin marrying on Wednesday morning.

On Oct. 7, the 9th Circuit Court struck down both Idaho and Nevada’s gay marriage bans.  Marriages were allowed to begin immediately in Nevada, but the U.S. Supreme Court issued a stay after a last-minute appeal by Idaho officials, temporarily putting same-sex marriages on hold in the state. On Oct. 10, the nation’s highest court said Idaho could proceed with same-sex marriages.

marriage equality marriage momentum hrc

hilarious blogger

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Every once in a while on slow days at work, I peruse the internet looking for newsworthy articles to blog about or the latest funny blog.

Well, today I found one.

It’s titled Where Am I? and it’s hilarious.  Kristin’s musings on co-ed gyms are funny as hell.  And her post “Why Pinterest is Ruining Weddings” begins as follows:

I like Pinterest. I have many boards that keep me humble including “Foods That I’ll Never Make” and “Crafts I have No Time For,” because let’s be serious for a minute. Yes, that 5 layered dessert with about 50 ingredients looks amazing but in reality I have no patience to make something like that and will show up at a cookout with a box of cookies (store bought!).

Check it out – you might get a laugh or two.

Marriage Equality meets Appalachia

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The West Virginia Attorney General announced today that his office will no longer fight a court challenge to West Virginia’s ban on same-sex marriages.  West Virginia Attorney General Patrick Morrisey issued a statement Thursday that his office “will respect” the recent U.S. Supreme Court declining to review the 4th Circuit Court’s ruling in July striking down Virginia’s ban on same-sex marriages.

U.S. District Judge Robert Chambers in Huntington had previously put West Virginia’s case on hold. On Tuesday, Chamber ordered the state and clerks in Kanawha and Cabell counties to respond to a motion by plaintiffs by Oct. 21.

West Virginia’s Governor Earl Ray Tomblin added:

I do not plan to take any actions that would seek to overturn the courts’ decisions. West Virginia will uphold the law according to these rulings, and I have directed state agencies to take appropriate action to make that possible. Our state is known for its kindness and hospitality to residents and visitors alike. I encourage all West Virginians—regardless of their personal beliefs—to uphold our statewide tradition of treating one another with dignity and respect.

west virginia marriage equality

Marriage Equality in the Silver State and Potato State

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The 9th U.S. Circuit Court of Appeals in San Francisco ruled today in pending appeals on marriage equality bans in Idaho and Nevada.  The court, led by Judge Stephen Reinhardt, struck down the gay marriage bans in Idaho and Nevada.  The ruling comes a day after the Supreme Court effectively legalized gay marriage in 5 more states and opened the door in 6 other states when it rejected a set of appeals.

The appeals court ruled that gay couples’ equal protection rights were violated by the bans. Judge Stephen Reinhardt said during oral arguments in September that he expects the Supreme Court ultimately will decide whether gay marriage bans are constitutional.

The opinion, issued by Judge Reinhardt, reads:

We hold that the Idaho and Nevada laws at issue violate the Equal Protection Clause of the Fourteenth Amendment because they deny lesbians and gays who wish to marry persons of the same sex a right they afford to individuals who wish to marry persons of the opposite sex.

9thCircuitVictory marriage equality

Prepared to play doctor?

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I’m not sure how I missed the article, but one of my favorite New York Times bloggers wrote a piece in April titled “Are Med School Grads Prepared to Practice Medicine?”  I applaud Dr Pauline Chen’s attempt to discuss the variability of medical education across the United States and the need for more uniform standards and testing, but the resounding answer to this question is obvious and is absolutely no.  Reading the comments on this article (something I keep telling myself not to do but somehow cant avoid) would make you think that every young doctor out there is completely incompetent and therefore is not ready to practice medicine.  My opinion might be unpopular, but I would argue that not being prepared to practice medicine out of medical school isn’t necessarily a bad thing.

I’ve often commented that medical school is the time for learning how to act like a doctor, while internship is for learning how to actually be a doctor.  Part of the problem with preparing medical students to be physicians is that no amount of training can fully prepare you for internship.  As one of the chief residents this year, it has become all to clear how “preparing students to be doctors” is almost an insurmountable challenge.  Throughout their “clinical training”, third and fourth year students struggle with the tremendous amount of factual information they must learn in the chaotic environment of the hospital, while preparing for exams at the end of their rotations that are a test of knowledge rather than skill.  Additionally, students are often observing residents and attendings interact with patients, and rather than being the lead are often at the bottom of the totem pole, a situation that makes acquiring clinical knowledge much more difficult.  As it is, medical school still focuses on education for factual knowledge instead of clinical knowledge.

Interns are no different, and their learning curve is particularly steep.  Surgical interns start out particularly handicapped – not only must they conquer the knowledge base of a medical doctor, but they must also acquire the skills necessary to be a young surgeon.  But a solid knowledge base of medical facts does not ensure that a student will be prepared to be an intern; the critically important part of intern year is learning accurate clinical judgments.  Learning that skill that takes variable amounts of time to acquire from resident to resident, and among attending physicians, some will always be better than others.  Interns are also charged with taking care of far more patients than their student counterparts, and while the amount of responsibility students have varies across medical schools, interns are directly involved and responsible for patient care.  Part of learning to be a physician is well… actually being a physician.  If students came in fully prepared to practice, what would we need residency for?

I firmly believe that nothing can fully prepare you for the first time your pager goes off as an intern and an emergency in one of your patients awaits you on the other end of the line.  But perhaps there is room to do better in training medical students.