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Wednesday, February 16, 2005

Many Kinds of Bad 

There's an old, probably apocryphal, story about a Chinese curse which says, "May you live in interesting times." Well, here we are; another semi-philosophical curse is ruined for a generation or three.

Gay and lesbian people are the current targets of much of the world's ire these days, particularly in the United States. Not even mentioning the looney toons of the so-called religious right directly (it's too easy), theoretically serious and mainstream groups are on the bandwagon. The president of the American Medical Association this week spoke out in defense of the New York College of Medicine's ban on an LGBT student group. This actually makes me so insanely angry I have little to say about it - go visit Graham for the story.

On the less-surprising-but-maybe-more-horrifying side, the Substance Abuse and Mental Health Services Administration (SAHMSA) has "requested" (meaning, actually, "ordered") that organizers remove the words "gay," "lesbian," "bisexual" and "transgender" from the program of a federally funded conference on suicide prevention originally titled "Suicide Prevention Among Gay/Lesbian/Bisexual/Transgender Individuals." Because we don't want anybody actually knowing what it's about. The level of stupidity here are beyond my comprehension.

On the other side of things, the unintentionally bad, a new study indicates that older doctors tend to deliver lower quality care than younger ones. One explanation for this is the recent shift to "evidence-based medicine," in which older doctors may not be trained or comfortable practicing. There are a number of worrying aspects to this for me. First of all, measures of care quality are slippery (a good bit of my job revolves around them), and can sometimes be de facto advantages for younger doctors. This study is from a very well regarded group and published in a very reputable journal, so it's probably safe to assume that's not a major issue here.

Where it will become an issue is the second, and more major, of my concerns. Stories like this in the popular press stir up trouble (see, for instance, last night's episode of Scrubs). That's what they're designed to do: scary/shocking stories are really good for ratings and readership. The problem is, you get a generally clueless public clamoring for Something To Be Done, and you get hasty, counterproductive new rules and legislation. "Toughening up" recertification requirements might be a good idea, but not if it's based on measures that give unwarranted advantage to younger doctors. We already have a care provider shortage in this country, the last thing we need is all the ones with more than five years experience being put out to pasture. So what's the solution? I don't know, but it probably requires careful consideration and study and will be complicated and incomprehensible to the general public. In other words: politically infeasible. Oh well.

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