Thursday, June 2, 2011

Macho Man!

The very driven Maggie Mahar has a sweet takedown of little old me over at her Healthbeat blog. Please go check it out pronto. I've read through it a couple times, in addition to the attached comments, and I must say I honestly feel thoroughly Tressel-ized. I learned quite a few interesting facts about myself of which I was heretofore previously unaware. According to Ms Mahar I am pretty much an asshole who manifests a "macho" attitude toward patient care. I exhibit paternalistic and faintly misogynistic chracteristics. I have no compassion, in fact I have "contempt", for the poor and uneducated patients of America. I'm also not very eloquent, an assertion I wouldn't ordinarily object to, but it certainly isn't because I haven't been "a regular contributor to the New Yorker". Adam Gopnik is horrible. And I can't stand Hilton Als and Sasha Frere-Jones. Tom Junod at Esquire writes circles around everyone at the New Yorker. But anyway.

The bottom line is this. I agree with Atul Gawande on some things and disagree (vehemently) on others. We can have a back and forth debate like gentlemen. But that wasn't the point of my previous blogpost. The point was to draw attention to the fact that the commencement address was lame and uninspiring and completely inappropriate, given the context. I mean, this was a medical school graduation speech! The graduating students had just spent the past 12 years grinding through a very rigorous and exhausting phase in their lives. And now they are to embark upon a life of selfless labor, dedicated to the well being of their future patients. To use that moment as an opportunity to give a wonkish health care policy speech is entirely self-serving and, well, boring.

In fact, Dr Gawande was in the area last weekend when my little sister got married. I saved the transciption of his wedding toast:

"Jen and Brandon, congratulations on your recent betrothal. I know it's exciting and all but please beware of indulging your romantic fantasies too much. The truth is, we Americans don't do so well at the institution of marriage. Over half will end in divorce. Domestic violence is on the rise. Children can be emotionally scarred by the fallout from broken homes. I would advise you to throw away your Shelley and Lord Byron, your Shakespearean sonnets, your anachronistic Valentine's Day traditions. Such mindlessness is old school and inappropriate in the modern age of love and marriage. Instead, I would encourage you two to engage one another in more actionable displays of a solid married life. Instead of random weekend getaways, consider a more robust, algorithmic approach to love. Those warm fuzzy feelings you get from time to time are completely unpredictable. Do not trust them. It is a cowboy mentality to lose yourself in a sappy loving brain goo. You have to collaborate in a pro-active, value added fashion. My wedding gift to you is a special Love Checklist that I have released to you, free of charge, prior to its intended publication date in the fall. Please review it and implement its tenets and re-purpose its structure for your own needs. Thank you. Again, my heartfelt congratulations."

/cue electric slide.


Afraid said...

Could it be that the belief on the part of some wonk-bloggers that you have comtempt for patients is projection?

They may have deep seated contempt for patients that is exhibited in a belief that you must harbor the same viewpoint.

Maybe these blogger-wonks have deep seated contempt for doctors. If so, it wouldn't be out of character to be disrespectful under a veil of piety.

I think in a way that many bloggers are subject to the same forces that seem to drive TV news to sensationalize, polarize and cause conflict. They also seem to have the same problem newspapers have with a conflict of interest between their funder/employers and the truth.

AB said...

Your blogging is some of the best I've read, particularly the post on Salinger and your post describing the Forgotten Man. Both were vividly written, inspiring, and true to my limited experience as a clinician. Gawande will have his defenders, especially in an environment such as Boston, where ultra-specialization can effectively blind clinicians to the realities of practice outside their given field and necessitates the integrated multi-disciplinary approach that he advocates. Your takedown of his speech was spot on. Ignore the haters!

Anonymous said...

Uh oh, you really upset "it". Hahaha, and be careful because she likes to take sentence clips from you and use them out of context. I think that if anyone actually read your posts in their entirety, they would view you as a physician who deeply cares about and respects his patients. (And FYI Maggie, medical school debt isn't "tens of thousands" but hundreds of thousands.... that quite a difference. Learn your facts.)

maggie mahar said...


My post wasn't a "take down" of you -- it was a defense of Gawande.

I usually write about his New Yorker pieces. His piece inspired the post. Your reponse to it provided a news peg that would be of interest to my readers. Many are physicians; I thought that some would tend to agree with you, some wouldn't. Some would have mixed reactions.

Posts that stir some debate among my readers are a good thing: keeps people thinking and talking to each other.

i didn't suggest that your writing lacks style--just that you are not as eloquent as Gawanade. In my humble opinion, he is probably the best writer that the New Yorker pubishes.

I consider myself far less eloquent than Gawande.

maggie mahar said...

Since your blog doesn't allow comments over a certain number of characters, here's part 2 of my response:

As to what is or isn't appropriate to say at a med school graduation, one of my readers commented:

The only conclusion I could draw from Buckeye Surgeon's post is that he's never actually taken the time to read The Checklist Manifesto or Dr. Gawande's New Yorker article on the subject.

But then again, Buckeye Surgeon thinks the graduation address should have been 30 minutes of "y'all are awesome" congratulations"
From what you say here, I guess he's right.

You can look at G's speech in different ways. I didn't see it as negative, I saw it as inspiring. Gawande was telling them: you can lead health care reform, and a new era of care.

Some people like the idea of collaborative care; others don't.

Anonymous said...


I don't think Gawande is looking for a Barney Fife.


Soren said...

The most important thing possible is to like things the correct way and in the correct measure. You, guilty of loving your work and writing quite explicitly on the subject - you, frequent expounder of opinions carefully backed with experience and knowledge - tread dangerously close to loving a little too well.

Eloquence is a thing best used to make dry sermons a little more palatable; the reduction-ad-economum of Gawande is eloquent. It is not a thing that belongs outside of magazines and other vetted sources. You and your indiscriminately passionate writing... public policy heresy. Guilty of extreme eagerness. There's nothing for it, sir; we'll have to take away your keyboard and return you to the operating room since you think you love it so much.

Anonymous said...

Honestly, nothing beats the dean of students at our medical school criticizing the White Coat as a horrific vector of infection and disease and overprivilege ... in the only speech at our White Coat Ceremony ...

I'm not saying the dean was wrong, I'm just sayin' ...

[sorry for the anymouse post - wordpress ID isn't working]


Mark Graban said...
This comment has been removed by the author.
Anonymous said...

Did you really just come to a mans blog, which he does as an avocation, and insult him by saying hes not as "eloquent" as a writer who is renumerated for his writing?

Did you really just try to cover the insult with lame self deprecation about your own eloquence?

Were you born in a barn?

Could I recommend that you put the keyboard down for a while, take a break from your pie in the sky theories of helping poor people, and actually get off your rear end a go personally visit some real poor people? The time you spend with them will do much more for the world than throwing
them a free $100 primary care visit or insulting some random bloggers literary skills ever will.


Joe Says said...

But Maggie, no comment about your comment about how buckeye has contempt for his patients??

I take it you must be his therapist, supervisor, or patient to know this?

Maybe it is just omniscience of the gifted.

Or perhaps it is just desperation.

Alice Robertson said...

This is really interesting...what the Internet does best. Gives a voice to people like me...patients an inside glimpse at the dark side of medicine that fuels the fire...frustrates doctors too much....hurts patients. Creates heroes like Atul Gawande....who I like very much...but, like you, disagree with. Sadly, I disagree with Maggie's writings of much I find myself wondering....thinking as I read these highly promotional, partisan pieces...surely it is not just the hospitals that are coin operated? All this moral superiority under the guise of's empty few do anything beyond that on a personal level.

I may not agree with you...not sure yet....but how nice it is for us to sorta peek behind the curtain at dialogue that needs to take place. Oh yes...we may be this may be more like a chat over the cyber backyard fence:)

Anonymous said...

Maybe it's just me, but I can't take any adult seriously who goes by the name "Maggie"
OK, former English Prime Minister Thatcher used it once in a while, but when she was killing Argentinians/IRA terrorists she was "Mrs. Thatcher"...
and funny how when it's 3am and the aortic graft's leaking, the lungs aren't lung-ing, and the kidney's aren't kidney-ing all these "No I in Team" homos are home in bed...
I mean thats where I am...

Frank "Me-My-Mine" Drackman...

Jeffrey Parks MD FACS said...

Mark Graban-
Not sure why your comments won't post. I approved it for publication. Try not to get your panties in a bunch, though. It's unseemly. You could try again.

You really believe I'm advocating for a "y'all are awesome speech"? Amazing you're able to read my thoughts, able to discern a deep flippancy to my personal outlook. Thank you.

Again you are projecting straw man obloquy onto me by insisting that I am somehow anti-checklist and anti-collaborative care. Not to mention the arguably slanderous professional defamation you engage in by declaring that I have "contempt" for poor, underprivileged patients. (Presumably because I think allocating federal tax dollars to a social work bureaucracy that exists to make sure people know how to call their doctor or program their cell phones is a poor utilization of resources.)

Mark Graban said...

Interesting how you complain that you're being accused of being "anti-checklist" when your last post was clearly anti-checklist.

Blaming your readers for somehow misinterpreting what you wrote is unseemly. If you're constantly being misunderstood, try writing more clearly, perhaps?

Jeffrey Parks MD FACS said...

Monsieur Graban
I'm not anti-checklist.
I'm anti-making a speech about checklists and the relative irrelevance of individual practitioners, when given to a bunch of med school grads.

I do a checklist-inspired timeout every day in the OR. I like it. I'm in favor of it. I think anything that reduces the possibility of chopping off the wrong leg during a scheduled amputation is a good thing.

But to extrapolate and say "see, individual talent and work ethic is irrelevant in modern medicine; simply join a pit crew and perform a singular, repetitive task for the rest of your life according these strict guidelines and we'll call you a great doctor", is asinine. As far as collaborative care goes, that is a complex topic that could be hashed out over several blog posts. Does every patient need a separate consultant for each organ system while hospitalized? How is the care to be coordinated? Who is the ultimate decision-maker? Collaboration is good; the extent to which we are expected to collaborate and involve specialists is a different matter.

Hopefully that clarifies things for all.

Alice Robertson said...

In reading the posts it is hard to tell if this is about a type of fan club lynch mob, or an ideology beong discussed. They say intellectuals care more about ideas than people, and it seems both doctors here care about people.....yet, some people try so hard to intellectualize they forget the real purpose in the discussion.

My daughter has cancer...her surgeon is brillant (wins best research awards, etc.) but he felt what I shared from Dr.Gawande was a bit sensationalized...while I found his warnings/writings about amateur residents not just scary....I was bloody well terrified.

It seems like a great conversation if the emotional reactions of over protectionism about Dr. Gawande could be removed. There is room for other, unpublished, doctors at the table. I am not sure I understand the knee jerks....because it seems like we all want the same outcome....

Not that doctors can't be hard of hearing....sometimes their careers seem to create demigods:)

Gary M. Levin said...

The Next Generation of Medical students will have to make their own decisions, not us. It will be their world, our generation has pretty well messed up not only medicine, but education, foreign policy, and the financial world. Why should they listen to us. If they had a good education (not training) they will figure it out. I agree but i would not say it was was rude, ill mannered, and neglected the excitement of the moment. It is going to be hard enough without forecasting something that may or may not actually occur.

Bianca Castafiore? said...

well, maggie mahar is just stupid. and calling her a wonk-blogger is a gift...

[how am i doing? did i take the bate? i have to admit that federer has my attention at the moment... which can only mean... ALLEZ, NADAL! 5-ALL SECOND SET...]

whatever. you are an awesome blogger of the first order. for maggie's benefit, i'll explain that a blogger of the first order is someone who writes of what s/he knows, convincingly and well. [those are the requisite adverbs, miss maggie. please don't tell me i am the first to call you "miss maggie." i mean, *really*, there must be at least some old lover out there who has screamed in your (somnolent) ear:


for what it's worth, i wrote my take -- that'd be the patient's take -- on the checklist (oops, free advertising for your next post, pit stop!)... last september:
cleverly called The Checklist.

Anonymous said...

Honestly, why would you care what Maggie thinks? Frankly, I stopped reading her crap long ago. She has an agenda and is good at only quoting studies supporting her agenda. She also does a piss poor job of actually critically reading the study rather parrots the conclusion. Then throw in a complete lack of hands on knowledge of our field. Frankly, I would personally take the slight ( I don't know what it i said I refuse to read the shit she shovels) as a compliment.

Anonymous said...

In the very most precious development, we find that Gawande's speech has been plagerized!! It's so good plagerizers like it!

"Medical students at the University of Alberta are disappointed after they say their dean copied a graduation speech.

Students say a speech given by dean of medicine Philip Baker during a convocation banquet Friday night, which told personal stories about how medical science has helped his wife and children, was lifted from a talk given by surgeon Atul Gawande at Stanford University's 2010 medical school convocation."

I laughed till I cried.

Gary M. Levin said...

My first reaction to Maggie's comment about the number of physicians increasing from 2.5/patient to over 15/ patient at Johns Hopkins Hospital is that it must cost far more with 15 doctors than 2.5 . Not exactly is the 0.5 (med student). This sounds like supply far exceeding demand, which of course generates more billing and needless procedures. Am I missing something?