Recently an emergency medicine doc who practices in Appalachia published this little story in one of the EM profession publications: Jim Bob’s Terrible Confession
His closing comments are what I wanted to discuss here. I think a lot of us who work in healthcare end up becoming a bit jaded after dealing with several patients who act like the people depicted in that story. EM docs in particular are often pretty jaded about this stuff since they have become de facto primary care doctors to everyone who doesn’t have insurance (which includes normal-acting reasonable people but also some dirt bags who think the whole world owes them).
I’m curious though about what people outside of the healthcare field think of this commentary. Do you perceive it as “judgmental” or do you think the author is correct that society needs to stop tiptoeing around the issue of subcultures that encourage personal irresponsibility?
Daddy: Why don’t you two just shack up? Or get hitched if you have to? WalMart is a fine job for her. And you can, well, you can just go work until you get hurt or something.
It would make a great Chick tract. Just needs a few more "HAW HAW!"s and a lake of fire at the end.
I don’t know if judgmental is the word - maybe mocking? Dismissive? I certainly agree that there are subcultures that discourage personal responsibility, but in my experience, no one really tiptoes around that fact.
In the 1990s there were some rural Kentuckians who died of Creutzfeldt-Jakob Disease having gotten the disease from the consumption of squirrel brains. For those of you who do not know, squirrel hunting is still a fairly popular past time in some rural areas and there are folks who just love to eat scrambled eggs and squirrel brains for breakfast. Many of the doctors serving those rural areas were not local and found this practice to be somewhat abhorrent. (Honestly, my first reason upon seeing a news broadcast warning people about squirrel brains elicited the comment “you have to warn people not to eat squirrel brains?”)
The end result is that when doctors warned their patients, which, as medical professionals, was certainly their job, the patients picked up on their revulsion to the practice and they felt a bit put out. In short, the way the warnings were given damaged many medical relationships because the patients felt as though the medical establishment was judgmental. Now I wish I could remember the medical journal I read that in…
Of course that situation is a bit different from people taking advantage of the system for drugs, an illegitimate workman’s comp claim, or some other nefarious purpose. It’s just that medical professionals need to be sure their judgments don’t get in the way of treating the patient.
On another note, when I was younger I worked for a company in the accounts payable department providing our customers with refunds. When I started I totally believed almost every story the customers told me. “If I don’t get my refund I can’t pay my rent this month!” “Yes, I already sent in the forms a few days ago.” After hearing the same excuses over and over again I stopped believing them. I became a bit jaded. I can totally understand someone working the EM getting jaded on a much wider scale than I was.
Yes, it’s those damn worthless welfare cheats that make the Doctors write those prescriptions. What else could they do? It’s not like give pain killers to patients repeatedly over years would be malpractice or anything.
About time one of the professionals finally blew the whistle in a responsible fashion.
That’s about as subtle and natural as one of those 70s after school specials.
I do sympathize with ER docs constantly fighting off drug seekers. But sometimes it turns them into irresponsible, unprofessional dicks - at least in my limited experience.
A few years ago I woke up with a pounding, racing heart, pain, and numbness in my left arm. Sounds like a heart attack (even though I’m young) and it wouldn’t stop so I called an ambulance. I was totally polite to everyone and a good patient and the doctor comes in and asks me where I worked. I didn’t have a regular job at the time and said so. So she said “oh, so you’re one of those people who just sits on the internet all day reading about diseases and talking yourself into them then” and then conducted like a half-ass 30 second interview about medical symptoms with me. What the fuck? I hadn’t sought medical treatment in about 8 years, so I’m not remotely a hypochondriac, and I certainly wasn’t seeking drugs. Even weirder, for that matter, she told the nurse to give me morphine for the chest pain without bothering to ask me. The pain wasn’t that bad and I was like “wtf? Morphine for that? No way”. I can only assume her behavior was based on experiences with patients who overuse the ER, but man, how unprofessionl and fucking dangerous since she probably half-assed my diagnosis.
On a follow up appointment with a cardiologist, I had almost the same reaction too. Is there a fucking note in my file now or something?
The article linked the OP sounds like my in-laws…who live in Appalachia, oddly enough.
My spouse and I are trying to help a nephew who has expressed interest in going to trade school. The kid DID graduate high school - the very first person in his family ever to do so (my Other Half got a GED, not a HS diploma before going to college - yeah, he was the Jim Bob Blacksheep of his generation). Did his parents appreciate that? Hell no! They harangued him for at least three years that he was wasting his time in school and should drop out and get a job like a real man (ignoring the fact that it’s almost impossible to get a job these days without a HS diploma no matter how menial). Told he was being selfish and foolish and he wasn’t any better than anyone else, so who did he think he was staying in school so long? Oh, and the parents have their own pot farm in the backyard, dad’s got a felony rap sheet, both of 'em have “pain” all the time and the pills to go with it. Add in alcohol and domestic abuse - equal opportunity, I hasten to add, several times both have been transported to the ER by the police and place in opposite wings of the hospital to avoid resumption of hostilities. Daughter had two kids by 19 and I still don’t know if she was married ot either of the fathers, or if the guy (or was it two?) she was married to at the time was the father of either of them. It’s a family where women have become grandmothers at the age of 36, and great-grandmothers by 48.
Don’t get me wrong - I actually do enjoy visiting with them because, despite all that, they CAN be charming and gracious when they want to be but thank Og I live 700 miles away. That when, when the drama hits the fan, I can leave for home.
Oh, and I pass on the squirrel brains. I explain us Yankees can’t handle that sort of thing, so just go on and have my share.
No, I didn’t think the piece was particularly judgmental. There ARE people like that. The only thing jarring was the notion there was a book in the house - most of my in-laws don’t own books for the simple reason they’re either functionally or even totally illiterate.
Although the depiction was funny in a Tobacco Road kind of way, I don’t know anyone who would be particular surprised by the existence of such a family. The question is what do we do about it? We could expand social services and keep a Big Brother eye on people who are in the system, but that inconveniences the majority of people who are not abusers of governmental services. We can make it harder for people to get on disability, but it’s already an arduous task to begin with. Do we really want to penalize people who are truly in need of help just because a minority take advantage of the system?
I don’t how we would fix the problem. I wish the article had offered up some ideas.
I don’t think it’s “judgemental” as much as a denigrating rant against people who need help in different areas.
I don’t doubt that those sub-cultures exist, both in the Appalachias and in inner-cities, but the solution is not to cut them off from state measures (as the author seems to imply with his round-about way of “health care professionals speaking out” or whatever else that’s supposed to be a code for?); but instead, start projects that target different areas. Improve not only schooling so that all kids realize why learning is important, but also get the adults involved.
But then, if we talk about cultures of irresponsibility, a sense of entitlement unrelated to personal accomplishment and living off other people’s money and from the state, we also need to act on the wall street, the bankers and the CEOs, who swindle and steal money, get exorbitant salaries while running the companies in the ground, with tax breaks and bailouts from the state…
I hate it that certain people only rant against fraud from the poor but don’t care about fraud from the rich.
It’s welfare-queen ethnic stereotyping, that “these people” are poor because they’re lazy. The author says “inner cities” have these problems too, but if he had tried to write such an article about an inner-city black family, I suspect he would have seen how offensive it is.
It’s also a cop’s-eye view of society; when the people you’re interacting with all the time are the worst and worst-off elements of society, you start thinking the worst about everyone.
Addiction destroys families in all walks of life, and all subcultures have ambitious people and lazy people in them.
While the literary piece may or may not be founded in truth, his shout for personal responsibility need not go unheeded.
We have great personal responsibility and people need to stop trying to find someone, anyone else to blame.
How is he not “speaking truth to power,” which is widely lauded in the progressoverse?
Good for him for calling it as he sees it. As for being judgmental, every freaking body in the world is judgmental. It’s a survival trait, among other things. Not a thing wrong with it.
I am, in fact, a primary care doctor in rural eastern Kentucky. I’m in a teaching position now partially because I got tired of dealing with pill-seekers all day, but I still see patients both on my own and with students and residents.
His little family drama is not entirely inaccurate, but offensively cartoonish. The “don’t get above your raisin’” attitude is still around, but most people who want and are able to go to school and get a good job don’t meet that much resistance. Disability pays very little, so while it might look like a viable alternative to stocking shelves at Wal-Mart it doesn’t look very good compared to a nurse or teacher’s salary.
I’m just not sure what this dude’s point is. Is he saying that we should think less of people who fail to contribute to society and live by scamming doctors and government assistance? OK, sign me up for that. I judge such people every day. It doesn’t affect the medical care I provide them, but I don’t mind being harsh to people who are trying to put one over on me.
But what does he expect these people to do? Right now around here people who want jobs can’t get them. Fifty years ago people who weren’t college-bound but weren’t cut out for the mines moved to Ohio and Michigan to work in the factories, but where can somebody move in 2011 where good-paying entry-level jobs are plentiful?
We’ve got judgement aplenty. What we don’t have are solutions.
You’re not entirely wrong–doctors definitely helped create the drug problem in Appalachia, but rural doctors aren’t supplying very much of the illicit narcotics nowadays. Most of the underground trade around here is methadone, and I don’t know anybody–even the pain clinics–who writes it regularly.
The biggest culprits by far are the pain clinics in Florida.