Post of the Week

Post of the Week

Published December 3, 1999 5:52PM (EST)


Social Issues
Hedda Mothballs - 10:37am Dec 2, 1999 PST (# 36 of 38)

Why gentrification sucks by Hedda Mothballs.

As a resident of Washington, DC the gentrification that I have witnessed has affected me on several different levels.

1) I moved into an "up and coming" neighborhood nearly 2 years ago. To me this meant the area was diverse culturally and ethnically yet was still affordable.

2) As a young white lesbian-- who makes a livable wage at her non-profit job-- I wasn't the only one who wanted to live in an affordable diverse neighborhood. The cultural diversity is evidinced by the neighborhood restaurants: Mexican, Ethiopian, Brazilian, Cuban, Thai, West African, Carribean, Japanese, and Italian to name just a few.

3) Due to gentrification, the population of immigrants that made the neighborhood so unique are being pushed out into more impoverished areas. They are being ritually sublimated all over the city, except for areas where rich white folks are still afraid to tread.

4) What attracted the yuppies in the first place? Because the property was cheap and the mix of cultures was truly unique. What is on it's way out? The diversity of the neighborhood and the ability for non-yuppies to afford to live there.

5) Just last week I signed a new lease in a different, poorer part of town because I can't afford to live in the neighborhood anymore. I'm not the only one, and my sublimation is nothing compared to the sublimation of the many immigrants who live there.

A few months ago a Blockbuster the size of a half block was built... I think I smell Starbucks coming...

What has been your most emotionally rewarding trip?

Home and Away
William Froelich - 06:41pm Nov 27, 1999 PST (# 2 of 5)

A sojourn I took in 1996 from Illinois then west along our nothern tier of states as far as Montana, at which point I turned south through Idaho and entered Yellowstone's west entrance. I returned through Wyoming, crossing the Bighorn Mtns. and then through the flatlands of Nebraska and Iowa. The scenery was diverse and the most beutiful natural beauty I saw was a young waitress in a small town in Idaho. She was a real cowgirl, with a sexy stetson, tight jeans, and tooled leather boots. But I digress. The mountains were beautiful. It was the first time I had ever driven though mountains, although I had rode a train through the Coloradao Rockies in 1962. Yellowstone was spectacular and I was there at a time of year, the first week of June, when it was not yet crowded.

I enjoyed taking state routes and county highways. I never worried about getting lost, or about getting lost for long. After all, as long as you have gas, you seldom have to go more than 100 miles on any road until you find one that's on the map. I picked up a hitchhiker, too, which I know a lot of people say is dangerous, but -- hey! -- vacations should include excitement. He was a young man on his way to Seattle. A few miles down the road we spotted another hitchiker and stopped. It turned out she was a woman. After a few mintues of conversation she revealed that she suffered form Tourrette's(sp). After a few more minutes I said that it sounded to me that she suffered from more than Tourette's. "Are you an addict?" I aked. "No." She responded. "My problem is with men. I just can't say no. No matter how young or old they are or what they want me to do, I just can't say no." A grin broke accross the young man's face. About an hour later I dropped both hitchhikers off in Billings MT. The young man still had a big smile on his face.

Medical error responsible for 98,000 deaths/year!

Steve Jacobs - 09:05pm Dec 2, 1999 PST (# 8 of 9)

I'm a practicing pediatrician of about 20 years so I have a perspective on this problem.

I'm skeptical of the solution that the National Institute of Medicine is proposing and here are my reasons:

If you actually read in detail about their suggestions you see something that hasn't been discussed here. They propose that the problem of error in hospitals be approached not as one of assigning blame but rather in correcting the defects in the system that allowed the error.

This is all fine, high minded stuff. But until the "blame" part is removed (or somehow greatly altered) then no one is going to come forward voluntarily.

I can tell you from the personal experience of being sued that no one is going to do anything that is going to do anything that might even possibly increase the liklihood of a suit.

Now, of course, the obvious response is that the threat of a suit forces us to do better work and, indeed, it does. However, as the article points out, errors always will occur; if every one of these accidental deaths resulted in a malpractice suit against someone, I suspect that the entire medical/legal/court system would collapse.

The bad folks like Dr. Swango are rare and no system of voluntary action is going to influence them. Most of us are far harder on ourselves than any court system will ever be. As the article said, we all have made errors and we all replay them over and over. I guess for ever.

If only all this effort went into systemic changes, the situation might eventually get better. One of the earlier posts in this thread is a perfect example-- that of the elderly patient who had been prescribed 15 drugs, some of which conflicted with each other. So who's to blame for this: Well, it may have been a single doc who screwed up. But more likely, it was several docs -- each acting in what seemed to be the patient's interest unaware of the actions of the others. Or maybe one or more of the docs didn't know about an adverse interaction. It may have been partly the patient's fault--perhaps she mis-informed the docs of what she was on. The pharmacy should have caught all of this, but perhaps the prescriptions were not filled at the same drugstore, so they couldn't check for interactions.

So what's wrong here. It could indeed have been error of the doctor(s). That's the individual error. But what of the system errors: Why isn't there a unified, instantly accessible medical record? Why isn't there an instantly accessible system for checking for interactions (does anyone realize how long it would take to check -- manually -- for interactions between 15 medications?)? Why don't all pharmacies keep a unified prescription registry (in the absence of a unified medical record)? These are the systemic problems to which the institute is referring.

How do you solve these problems: with lots of money. I can tell you that as a practicing physician I don't have the capital to invest in systems like these. Large HMOs that employ docs (called "staff model" hmo's like Kaiser in California) can do this kind of stuff but not us individuals.

So, in conclusion, I'd like to say two things: first, people aren't generally going to publicly confess to errors if they are going to get clobbered for doing so and, second: someone needs to look at the system as a whole and try to fix that rather than get caught in the details.

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