Tag Archives: tv

The Dreams of the Founders of Family Medicine

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Marcus Welby MD on the phoneLaurence Bauer has been an ardent, longtime advocate of family medicine. Among other things, he is Chief Executive Officer of the Family Medicine Education Consortium, a not-for-profit corporation that encourages and supports collaboration among Family Medicine Residency Programs and Departments of Family Medicine.

Larry and I met thanks to our mutual interest in Marcus Welby, MD. The practice of medicine has changed dramatically since Dr. Welby inspired doctors to become practitioners of family medicine. Yet each time I talk to Larry, I’m reminded of today’s dedicated students and physicians who want to practice comprehensive care with the same concern for the whole person that Welby expressed for his patients. This remains a timeless value of the medical profession, and for Larry, it’s important to keep that value alive in an age of narrow subspecialties and corporate medicine.

Family Medicine as a specialty (a three-year residency after medical school that includes the study of internal medicine, pediatrics, obstetrics-gynecology, psychiatry, and geriatrics) emerged in the late 1960s. Those who initially endorsed family medicine wanted to change the direction of medical culture and influence its future. In the words that follow, Larry addresses those early visionaries. I’d like to thank him for allowing me to share his thoughts.

The Dreams of the Founders of Family Medicine

When poetry strays too far from music, it atrophies. When music strays too far from dance, it atrophies – Ezra Pound

As Family Practice emerged from the field of General Practice, it is important to realize that many in and out of medicine told the founders they would not succeed. The cynics believed that the dominant forces in medicine were too entrenched and there were too many societal forces working against the idea of a generalist renaissance in medicine. “Real” medicine of the future aspired to something more worthy. Real medicine involved care of hospitalized patients and was informed by the scientific and technological advances associated with sub-specialty medicine. Anyone could care for the people “out there”. But the founders dreamed big, bold dreams; they were a determined and visionary group. Read more

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Why do we feel bad about the way we look?

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Laurie Essig’s new book, American Plastic: Boob Jobs, Credit Cards, and the Quest for Perfection, includes a chapter on how we learn to want cosmetic surgery. She quotes Joan Rivers, from her book Men Are Stupid . . . And They Like Big Boobs: A Woman’s Guide to Beauty Through Plastic Surgery:

My abiding life philosophy is plain: In our appearance-centric society, beauty is a huge factor in everyone’s professional and emotional success—for good or ill, it’s the way things are; accept it or go live under a rock.

Heidi Montag cultural texts promoting cosmetic surgery

Essig comments:

But Rivers is a TV star. TV and movie stars have always utilized the miracles of cosmetic surgery to look good in the two-dimensional spaces they inhabit. How did the rest of us learn to desire a perfectly plastic body? How did ordinary women and men with ordinary lives and ordinary bodies learn that they need plastic? The answer: the plastic ideological complex, a set of cultural texts that are both highly contested and yet tightly on message. It is itself so ubiquitous that it might even be described as hegemonic. In other words, the “need” for cosmetic procedures is impossible to avoid. Through advertising and TV shows, movies and magazines, we learn to want cosmetic intervention in our aging faces and imperfect bodies. This need is now so firmly implanted in our cultural psyche that it has become “common sense” to embrace cosmetic procedures. Why wouldn’t we want to look more beautiful, younger, thinner, more feminine, better? The question is no longer will you have plastic surgery, but when.

Accept plastic beauty or go live under a rock. Rivers isn’t just joking; she’s also doing the serious work of enacting the ideology of plastic, an ideology that we can no longer avoid. Even if we did live under a rock, whenever we crawled out from underneath it, we would be assaulted by images of perfectly plastic beauty on billboards and the sides of buses and on TV and in movies and even the nightly news. And then there are those damn magazine racks, an unavoidable gauntlet of Dos! and Don’ts! that must be passed through each and every time we buy our food.

A conspiracy of capital to make us feel bad

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Grey’s Anatomy donates a body to medicine

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Grey's Anatomy Meredith Cristina GgeorgeWhile studying anatomy, I once spent a day with a cadaver whose stomach — normally located in the abdomen below the rib cage — had migrated up through the diaphragm and was now located behind the ribs. This was not simply a sliding hiatal hernia, but the rolling kind that occurs only about five percent of the time.

The body belonged to a small Asian woman. Her unusual condition may have been uncomfortable in life, but it had not prevented her from living for a very long time.

I wondered what prompted this woman to donate her complete body for use as a medical cadaver. Perhaps it was her unusual condition. By being a cadaver, she could acquaint thousands of students with the possibility of a rolling hiatal hernia. A description in a textbook is much less memorable than seeing the real thing. Of course with modern imaging technology, one almost doesn’t need to see a real cadaver these days.

I thought of this woman recently while watching an episode of Grey’s Anatomy, an extremely popular TV show that’s more soap opera than medical drama. I watch the show after it’s available on DVD, which is why I’m currently viewing last year’s episodes (season six). This was the season in which the young resident surgeon, George O’Malley (played by T.R. Knight), did not return. Read more

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Marcus Welby vs. the specialists

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Marcus Welby MD with young patientIn the very first episode of the TV series Marcus Welby, MD, our hero delivers an after dinner speech to a group of young interns. As he’s introduced, he hastily scribbles the title of his talk and hands it to the hospital director: “The future of the general practice of medicine, if any.” The year was 1969.

In his introduction, the director somewhat tactlessly remarks that many “eminent specialists” have addressed the group in the past, but tonight they have a general practitioner. After acknowledging this, Welby continues:

Don’t apologize, You’re right. That’s what everyone thinks. Tell me, doctors, are you a specialist or a GP? Or sometimes they say “or just a GP?” But of course we are specialists. And our specialty, like any other, has certain advantages and certain disadvantages. The money is good, but you have to work three times as hard for it. But you people know all about that.

Since you’re about to choose your specialty, you’ve been amassing information about each. Psychiatry, we know, is practiced sitting down. Dermatologists don’t make house calls.

General Practice is performed standing up, sitting down, outdoors, indoors, wherever there’s illness. And that means everywhere. Because, gentlemen, we don’t treat fingers or skin or bones or skulls or lungs. We treat people. Entire human people. … Read more

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Sesame Street’s When Families Grieve

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Military father and children

Source: Rough Notes

One in 20 American children under the age of 15 experiences the death of a parent. For military families, the rate is even higher.

Tomorrow night (April 14) Sesame Workshop, the nonprofit educational organization behind Sesame Street, will present an hour-long special on losing a parent. It airs on PBS at 8:00 PM ET/PT (check local listings).

Katie Couric will host the special. Her daughters were two and six years old when she lost her husband 12 years ago. The program, called When Families Grieve, is designed to aid communication between adults and children on this difficult subject.

Sesame’s outreach initiatives harness the power of the Sesame Street Muppets to aid the communication between adults and children through strategies and language that are child-appropriate and useful for the whole family.

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‘Mad Men,’ the sixties and the culture war over health carepolitics

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John Hamm as Don Draper in Mad Men

Source: The Insider

The current emotional polarization around health care reform is not so much about specific issues – rising medical costs, reprehensible insurance industry practices, the number of uninsured. It reflects a deep division in American culture that began in the sixties.

Forty years after Woodstock, it’s clear that a major shift happened in that decade, politically, socially and psychologically. Despite the communal love fest, Americans had begun “bowling alone.” Crime rates started to rise, as did divorce rates. Quite suddenly, in 1965, a vast majority of people stopped identifying themselves as Democrats or Republicans and became Independents.
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Health Culture Daily Dose #8

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    Health care reform
    Wyden-Bennett plan, Fundamental Democrat/Republican differences, Gawande on building from what we have)

    The Medical profession
    (Stress vs. balance for doctors, Doctors’ Diaries on NOVA)

    Health care reform

  • Last week’s figures on cost and coverage from the Congressional Budget Office (CBO) shifted attention to those health care reform initiatives that are less costly. One of these is the Healthy Americans Act sponsored by Senators Ron Wyden (Oregon Democrat) and Bob Bennett (Utah Republican). The Wyden-Bennett plan rules out a public option (insurance from the government), but requires an individual mandate (everyone must have insurance). It taxes health benefits, although there would be a $19,000 income tax deduction for a family of four.

In an interview with The Wall Street Journal, Senator Wyden argued that it’s far better to pass a bill with broad support from both Democrats and Republicans than to use the reconciliation option. Otherwise you’ll have members of Congress trying to repeal the plan as soon as it’s passed.
The Wyden-Bennett plan combines the Democrats’ desire to have everyone covered and the Republicans’ interest in relying on the markets and preserving consumer choice. The Healthy Americans Act is supported by 14 Senators. Many Democrats are skeptical, especially those with ties to labor unions.
On unions, Wyeth says:

Unions have every right to bargain for the best possible package …. “But nobody, be it a CEO or a labor [union] member ought to be getting what amounts to gold-plated coverage with the tax subsidies paid for by somebody who is a modestly compensated woman at a small business who doesn’t have a health plan.”

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EBM provider Bazian uses Scrubs to make a point

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A few more things about Bazian, the company that provides the evidence-based medicine (EBM) analysis used by Behind the Headlines. (Bazian, BTW, is named after the 18th century mathematician Thomas Bayes, as in Bayesian probability.) Those who work at Bazian call themselves evidologists. “Evidology aggregates, filters and synthesizes the entire universe of research about a given question into one odds-based answer.” Hmmm. Well at least they’re the first to admit this sounds grandiose. But they insist it’s not: “If you’re not using evidology then necessarily you are basing decisions on opinion or individual studies, and these routinely turn out to have been wrong.”
Bazian has a colorful, casual, good-natured presentation on their website about EBM and what the company does. (See Sources below.) There’s even a slide of Doctors Kelso and Cox from Scrubs.

Scrubs doctors

Ahh yes, the change in the doctor/patient relationship. That’s a subject for numerous future posts.

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