Distractions and Biblical Hoes in the House of God

I still might be dead. I wrote this because I was on a roll after my last post and I'm in that miserable phase where I can't focus on much and can't do much because my lungs can't keep up unless I'm perfectly sedentary. Blogging is a good way to distract myself when I'm tired of reading.

And what a coinkydink, this post is actually all about the reading I've been doing.

Fair warning: I'm not fully oxygenated and I'm on steroids. This could be a hot mess.

So in my quest to understand what the fuck is medicine's problem, I've been going through various books on the topic. Some are interesting, some are weird. Let me tell you all about it...

How Doctors Think by Jerome Groopman is excellent. I now realize I have blogged about and experienced a lot of the biases and cognitive errors doctors have made with my health, but I didn't connect that there was a framework for categorizing them. I didn't realize someone had named them all. 

I really should have known, but I guess I had my own cognitive error going. I do have books on mental frameworks in a similar vein and I do use them in my work. I just failed to expand and extrapolate beyond my field. 

Let that be a reminder to always question the premise and examine your assumptions.

Unfortunately, there seem to be no global fixes in the works. We all know there's a problem, but no one seems to know what to do about it. AI or big data isn't yielding much help with this either, although perhaps that has changed in the last few years...I need to check to see what the current status is. 

I'd also suggest that some of the biases and ways of thinking are by design to serve a profit driven agenda. Even going so far as impacting textbooks, papers, and studies. Essentially, the Dark Money of medicine. I have some particular examples I'd like to maybe blog about at some point...I just need time to do put all my research together.

Then I picked up Diagnosis by Lisa Sanders which seems to be a compilation of newspaper columns about difficult diagnoses. She is quick to tell us that doctors get it right 95% of the time (OMG lol lol lol LMFAO) and then proceeds to spend the rest of the book discussing all the cases the doctors got wrong and the people they killed/almost killed as a result.

I'd like to see the study that says doctors are that good. I bet I can find some flaws. I'll have to go through her sources and dig it up. Has the number of years and doctors it takes to get diagnosed with basic things like thyroid issues decreased? I bet not.

So the book is meh at best. It's a very idealized look at medicine. Where all the consults possible are made and everyone is all too willing loop in a more experienced doctor, which I've never seen happen in any of my interactions with medicine despite having some pretty rare shit.

It's interesting that even an idealized look at medicine can't escape stories where the system harms patients.

Further, most of the case studies don't give you enough information to allow you to figure out what's happening, so there's no mystery to it. You have to read until she finally gives you the diagnostic clue that made the diagnosis. But without those clues, the cases are boring because the whole time you know she's purposely holding back information. You're reading pages and pages of just noise with no payoff.

I'm thinking it probably worked better as a newspaper column.

And even as she methodically catalogs all the ways doctors fail their patients, the book somehow reads very 'there there, doctors are good, don't worry your little head about a thing, we're the grown ups here.' Patronizing ick. Very weird vibe.

But it's an easy read. I'm covid chilling and reading it to distract myself. 

There are some interesting nuggets. It's not a total waste of time. I didn't know that cancer could cause depression, for example. That was eye opening. 

And did you know? You can just drive 600 miles to Mayo's emergency room and skip making any appointments. That's kind of ballsy, though. I also roughly knew the diagnosis on that case because I once had a version of it myself.

The patient history: Systemic immunosuppressants with severe rash starting in the hands and spreading. 

Well, I had a fungal infection in my cuticles after being on prednisone for so long back before the advent of modern asthma inhalers. It was very difficult and painful to get rid of. Luckily it didn't get too serious. 

I also occasionally get intractably sick enough that I've been assessed for whacky systemic fungal infections. So far, that's always negative. Thankfully. So on the patient end of medicine, I know some of the pattern here.

The second I saw immunosuppressant in the history and the fact her hands had a weird rash, I just knew it was fucked up fungal something that had gone rogue. Fungal stuff is stubborn as hell.

My question after reading that particular case was how was Mayo--600 miles away for the patient--the only place that could figure it out? Seems like something any physician worth their salt should be able to logically work through. 

All I could think as I read was, 'God. I hope her doctor didn't bankrupt her with that 600 mile drive to Mayo advice.' Yes. That was all her doctor could think of, to send her way way waaaay out of network. She was at Mayo for a month. She will probably never be done paying that bill. I guess her doctor was the rare one who didn't have any doctor friends to consult with.

There's also a case where the patient lied to manage the system that I thought was a good illustration of how patients are left with no good choices all too often. 

For me, anymore, medicine is like a video game quest. I'm trying to find the treasure and I'll smash all the things, push all the buttons looking for it because there's no map, everything you're told to do can easily be a dead end, being on the right path means nothing. You just never know where actual help is going to be, so look everywhere.

I am also trying to read House of God, but it's very dated and quite sexist with some really gross sexual assault. Not to mention racist and ego reinforcing (doctors are gods) and all its wisdom predates the advent of the MRI among other medical advances. It's really kind of amazing to me that it's still viewed as relevant. All the doctors still seem to read it (which makes me wonder how much content like that subconsciously reinforces bias) so I thought why the hell not. 

I'm not sure if I'll finish it. It's a bit of a slog. I'm having trouble understanding why this satire is such a cultural touchstone for physicians. I found it pretty dull and pathetic. And the ick factor when I realized I've seen doctors write eroticizations of their female patients on blogs inspired by this slop in recent times...Off. The. Charts. Ew.  

I'm not sure everyone understands Roy isn't a hero.

And just in general I'm still kind of huh on why anyone wants to read about some dick being a dick in a hospital setting. They say you have to read it after you've worked in a hospital. Unfortunately, I don't have that option.

God. It reminds me of the We Are Bros, Bros that were on the transplant team for my hepatic resection. They did actually act exactly like people who somehow wanted to reflect The House of God into the world. Huh. 

The book is also a very mercenary, blunt discussion of how hospital dynamics work. I really hope there's some effort in medicine to not just be punting patients as described in the book. Where I'm at now, the story is basically telling doctors to dump patients on some other specialty as much as possible, like a game of hot potato.

Patients are called GOMERs (Get Out of My ER) in The House of God which...funny story. I started reading this on a Sunday and happened to catch the last of the TV preacher as I waited for the news. Believe it or not, their topic was the story of Gomer in the bible. So I'm reading House of God and learning about the medical Gomer and then randomly catch this sermon snippet about the biblical Gomer.

What are the odds?

The biblical Gomer was an Old Testament 'whore' and God kept making her husband bail her out of jail after 'whoring' around and telling her husband to remain faithful. The whole story is creepy as fuck. There are consent issues all the way through and was Gomer really a 'whore'? Is this story really an example of God's love for us like the preacher believed? I'm not so sure. 

Although I guess making sure fundies know God loves sex workers too is probably a Good Thing. Love all, serve all, right? Too many fundies forget that. Do doctors also forget?

But the point is, all the folks in medicine using Gomer because of House of God probably don't know they are also taking a 'whore's' name in vain.

And I can see why God did a rebrand with Jesus. If Gomer's story is any indication, the Old Testament was super codependent and dysfunctional.

Oh. Wait. So is medicine. Ha.

All right. I'm off. I hope I survive to bitch about medicine another day. Peace.