Medical Humanities Blog

Disability & Media

Several major news outlets covered the story of Kellie Lim, a 26-year-old who graduated from UCLA Medical School last week.  This is newsworthy, apparently, because Ms. Lim is a triple amputee, having had both of her legs, an arm, and several fingertips amputated due to toxic shock secondary to bacterial meningitis.

And this is newsworthy because . . . (??)

Of course, Ms. Lim is to be congratulated on her achievements, especially in a society in which disablism is rampant.  But I am having difficulty comprehending precisely why there is anything surprising or unusual about the fact that a triple amputee graduated from medical school.  One of the most subtle and pernicious manifestations of disablism, IMO, is the triumphalist meta-narrative that is so pervasive in popular culture and media.  Narratives of disabled persons are packaged in ways that highlight the person's overcoming their "limitations" and "dysfunctions." 

This trope bothers me for several reasons.  First, it instantiates the medical model of disability, in which impairments are perceived as a lack, an abnormality, a dysfunction.  Second, though well-intentioned, it is often exceedingly patronizing.  Third, it has the unfortunate side-effect of stigmatizing all those who are, for whatever reason, unable to "triumph" over their disability.  Fourth, it implies that an impairment is something that ought to be overcome, conquered, vanquished.  It sets up a dichotomy between the individual and his/her body, between the "normal" self and the "disabled" self.  In so doing, it increases the likelihood that the disabled person will alienate herself from herself.  Given the stigma and alienation that all too often characterizes much of the experiences of disabled persons, perpetuating representations that foster the internalization of such stigma in the disabled person herself seems, to say the least, inadvisable.

An impairment need not be seen as something that must be vanquished or overcome.  Sontag's famous essay warns of the dangers of the battle metaphor in experiences of illness, and her concerns are applicable, IMO, to the triumph meta-narrative as applied to disability.

The CNN article notes that "Lim's teachers and fellow students said she exudes a calm that makes them and her patients forget her physical circumstances."

Why should Ms. Lim's "physical circumstances" need be forgotten? To be sure, recoil in the face of illness and disability is a human reaction that ought not always be castigated, but nor should it be celebrated, either.  The fact that many able-bodied persons would be initially uncomfortable in being treated by a triple amputee is understandable, but suggesting that patients should simply "forget" the physician's embodied self simply perpetuates the socialized features of disability.

Thoughts?

BLOGVERSATION: Jacqui over at Terrible Palsy.

Post on Malpractice Coverage

Charles Silver, a law professor at the University of Texas, has a fascinating post up at Tort Deform, the anti-tort-reform blog sponsored by the Drum Major Institute for Public Policy.  He discusses the results of several of the latest articles he has co-written (one of which is mentioned here).  Professor Silver opens with his own pathblography:

I recently suffered a grave injury during a hearing and balance test. The internal carotid artery on my right side dissected, a result of applying torque to my neck so a computer could get better readings from electrodes attached to my skin. A massive blood clot formed, blocking the artery 80-90 percent. I suffered blinding headaches, nerve damage, and other problems, and was hospitalized for over a week. Still, I count myself lucky. I’m alive and, apparently, I didn’t suffer a stroke. My doctors remain hopeful that, with time, I’ll recover.

He uses his narrative as a lens for contemplating (1) how often claimants receive compensation above and beyond malpractice policy limits; and (2) how much malpractice coverage (Texas) physicians typically carry.  He concludes:

This is the lesson of 14 years of medical malpractice litigation in Texas. Using a database of over 9,000 claims against doctors that closed with payments from 1990 to 2003, my colleagues and I discovered the following:
• Patients injured by medical malpractice rarely recover more than their physicians’ insurance policy limits.
• Malpractice payments stack up at the policy limits, suggesting that insurance policies cap recoveries even when patients deserve much more.
• Many doctors have small insurance policies. Almost 1/3 of Texas physicians with paid malpractice claims had $200,000 in coverage or less.
• Doctors almost never use personal assets to resolve malpractice claims. The claim that ‘every physician is one lawsuit away from financial ruin’ is a myth.

Fascinating.  I'll be interested to hear how AEI, among others, responds to these claims.  I also hope Professor Silver recovers fully from his injuries.

DIALOGUE: Ted Frank critiques Professor Silver's claims.

aren't we supposed to shatter, not set, ceilings?

My former home state of Washington has decided to further stigmatize and hamper those in need of chronic pain management by suggesting random urine tests for those taking opioids to manage their pain, as well as setting a maximum daily limit on dosing for opioids, 120mg of morphine or its equivalence.

While these are set as guidelines for primary care physicians who might not have the skillset to manage high dose chronic pain patients, the basic problem is that pain management specialists are scarce, and good ones are even rarer than that. And because these guidelines come from a government agency, there is real fear that they will be taken as rules, and not guidelines.

Aside from this though is the even more basic problem: the assumption that if you are taking opioids, you must be abusing other drugs and so should be checked up on via random urine tests. It adds insult to injury - not only are you not trusted to be honest about your pain, because you must manage it with an opioid, but they're going to tell you to your face that because you take a certain class of medication, you are untrustworthy enough that you must be subject to random urine screens.

What a lovely way to foster a healthy doctor/patient relationship.

Article Review

Several articles that may interest a medical humanities audience have appeared on SSRN.  Even better, most have full-text links.  Topics below the fold include: mental health in the penal system, purchase of human tissue for stem cell research, ERISA preemption and Massachusetts' mandatory health insurance, and a ground-breaking study on the actual effects of physicians' insurance limits on malpractice payouts (in Texas).

Interview

Nick Genes, the Blogfather of Grand Rounds, generally does a Pre-Rounds Q&A with all those unlucky fortunate enough to host Grand Rounds.  He asked some terrific questions, especially about the medical humanities, and you can read the whole interview on Medscape here.

New MA in Bioethics & Medical Humanities

The University of Louisville is now accepting applications for its brand-new MA program in Bioethics and the Medical Humanities.

Here's an excerpt about the program:

The program will enhance graduates’ contextual experience within their primary professional field, for example, law, philosophy, medicine, nursing, dentistry, religious studies, public health, health administration, or veterinary medicine. Degree holders may participate in hospital ethics committees, teach medical ethics and humanities, understand the interaction of religion/spirituality and medicine, or be equipped to interpret issues in bioethics to the general public and the media.

I've mentioned several times on this blog the humanist tradition of using theory to guide moment-to-moment practice; in some ways the medieval and Renaissance humanists were early translational researchers and scholars.  Hence I particularly like this paragraph from the UL program description:

Those students entering the program with a theoretical base will gain the tools to apply theory to real-world problems. Those entering with hands-on experience will gain the theoretical underpinnings for careful analysis of real-world problems.

Ad fontes!

Grand Rounds (Vol 3, No. 34)

 

(Jan von Calcar, Frontispiece to De corporis fabrica (1543), Vesalius.  The very fine Blocker History of Medicine Collection at UTMB's Moody Medical Library is fortunate to have an authentic 1543 edition of this work, and I have had the privilege of both touching its pages and gazing at this frontispiece, which is an extremely significant piece of the relevant (art) history).

The work, then, is both an important aspect of the medical humanities -- literally -- and serves as an apt introduction to Vol 3, No. 34 of Grand Rounds, the weekly fling around the blogosphere for all things biomedical.  For those of you new to the MH Blog, feel free to kick off your shoes and stay a spell, read some posts and engage us.  I did not expressly request a theme, and no meta-narrative captures the ecletic set of submissions for this week, though my crude categorizations are noted after each post.  No. 35 will be at ImpactED Nurse.  Enjoy!

______________________________________________

Amy Tenderich at Diabetes Mine ponders the significance of the side effects from the use of statins in managing high lipid profiles {EBM}.

At Medicine for the Outdoors Blog, Paul Sauerbach considers the tragic case of the New Jersey man who died of dehydration on a wilderness adventure {Standard of Practice, Liability}.

In Pallimed, Christian Sinclair reviews an important update in NEJM on empirical findings in the Netherlands regarding euthanasia {Palliative Care, Ethics, Policy}.

Cancer misdiagnosis is the subject of a post at Insureblog.  The horror! {Standard of Care, Liability}

Hospital Impact covers how patient blogs are changing healthcare {Pathblography, Metablogging}.

Healthline Connects reports on work being done to "Unravel[] the Mysteries of Neurogenerative Disease," and discusses the well-known case of Carol Carr {Research, Genetics}.

Want to start a blog but don't know how? The Clinical Cases and Images Blog gives a great how-to {Metablogging}.

David E. Williams of the Health Care Business Blog, a fellow Wesleyan Cardinal, discusses the reasons why employers should transfer wealth to their employees in exchange for better adherence.  Williams states that "As long as the programs are directed toward reducing overall medical costs than I'm not concerned about abusive promotional practices."  I disagree with this on a number of levels, not least because the propositions might well be dependent variables (don't abusive promotional practices tend to drive up aggregate costs? Such practices are ethically problematic for other reasons, as well), but the post is certainly worth engaging.

Kerri over at Six Until Me daydreams of a training and motivational session with fitness and diabetes coach Larry Bird {Pathblography}.

The latest installment of ED Sonnets is up at Rickety Contrivances of Doing Good {Pathblography}.

Sick of reading and thinking about DNA? Go all Mr. Wizard with Eye on DNA's Five Cool Things You Can Do with DNA.

TSCD continues her fine series on Med School Survival with a post on How to Survive Lectures (ed. - coffee?) {Humor}.

You know what they say happens when you assume? Sometimes worse than that, as Dr. George explains {Practice}.

The "Theme of My Day Was Fast" at ERnursery {Practice}.

Jenni Prokopy from ChronicBabe announces a book giveaway {Support}.

Dr. Val reminisces about her first day as an intern.  Move over, Sam Shem! {Practice}

Patient Anonymous adds another installment in em's insider account of being an inpatient in a psychiatric facility {Disability, Pathblography}.

Colin gives us a reflection on the place, if any, of race and ethnicity in medical care over at From Medskool, host of Vol 3, No. 36 Grand Rounds.  FWIW, I'm not at all sure it is a wise idea to try to entirely excise race and ethnicity from patient care, and I am dubious that it is possible to do so.  Of course, this is no justification for disparities, but if anything, the plethora of the empirical evidence of the latter suggests how much work needs to be done to remove even the manifestations of race and ethnicity that seem undesirable {Practice}.

In honor of Mother's Day, we have The Fitness Fixer's Healthy Mother's Day post, and some thoughts on the Day at Fruit of the Womb. {Ma!}

N=1 over at Universal Health warns of the blurry lines between managing care and practicing nursing without a license {Practice}.

Maggie Wallace marks Florence Nightingale's birthday (May 12) and International ME/CFS Day at Liverpool Leftovers {Disability, Pathblography}.

Joshua Schwimmer surveys the introduction of the first direct renin inhibitor at Tech Medicine.

Over at Notes from Dr. RW, Dr. Donnell attacks the scientific merits of CAM.  Michael, any response?

The NY Emergency Medicine Blog provides an interview with the Director of the New York Poison Control Center regarding the recent Diethylene glycol contamination from China.

Sue at Emergency Room Nurse stresses the importance of a communication in end-of-life scenarios {Palliative Care, Practice}.

Eliminating junk food may not be so easy, as The Family Fork's Andrea Giancoli explains.

Allen of Grunt Doc fame, who, like me, lives Deepinthehearta, sends good wishes to Scott from Polite Dissent {Metablogging, Pathblography}.

Mother Jones at Nurse Ratched's Place warns of seemingly dysfunctional families and the ER {Practice}.

At Aetiology, Tara Smith has a fascinating post on smallpox and vaccinations.  I'm actually taking a history of public health class right now and reading some about the smallpox outbreaks of 18th century colonial America, and some of the policy and public health problems Smith writes of have old lineage.  This is unsurprising under the dialectic model of history {Policy, Ethics, Public Health}.

And, last, but certainly not least, Bob Coffield proffers some thoughts on an area near and dear to my own heart (health law), in posts on tools for keeping track of regulatory develpoments, empirical assessments on technology utilization, and a new HIPAA Enforcement website at CMS. 

Disability Blog Carnival # 14

Disability Blog Carnival # 14 is up over at Kay Olson's outstanding blog, the Gimp Parade.  The theme is "Firsts."  Check it out, as well as the neat logo.

Grand Rounds Submission

Yes, the rumors are true.  We have the honor of hosting Grand Rounds this upcoming Monday.  Submissions have already been coming in, though there is no given theme yet.  I will review all the submissions and see if a theme presents itself.  Thanks.

Thanks

Though we try to keep the navel-gazing to a minimum, at some point in the next day we will pass the 10,000 hits mark for our little blog project over here.  Readership seems to be increasing as well, and I for one am extremely grateful to all who take time out of their day or night to engage us.  When I started this blog in September 2006, I said that the quality of this blog is mostly a function of the dialogue it facilitates, and I absolutely meant it.

I also have tried to stress that my vision for this blog project has always been to exist as a network for persons interested in exchanging ideas about the medical humanities, and in that sense, the more voices contributing to the discourse here, the better.  To this date, only brave Kelly has volunteered to guest-blog here, though I understand completely that not all have either the time or the inclination to author posts. 

In any case, I just wanted to thank our audience for hearing our voices, and to remind any who wish to add their own that space is available.