Friday, June 29, 2012

What I think.

 "I am a Grady doctor. What do you think I think?"

That's what I said today to the man in the Subway lunch line who asked me what I thought about the Supreme Court upholding the Obama's signature health care law.

You know. The one that will grant millions of Americans better access to health care and improve overall public health? Yeah. That one.

He said it kind of smug-ish and confrontational-ish. Which annoyed the crap out of me.

Then when I gave him my response he returned it with a snort and a half upturned smirk.

Yeah, he did.

I started to bite and entertain that smirk. I started to go in on him and ask him how much his Brooks Brothers suit cost him and also how many times as a child he'd seen somebody cook up some crack cocaine in the same kitchen his mama cooked dinner in. I wanted to ask him how many grocery stores were in his neighborhood and, if there was one, what was the ratio between it and the liquor stores. I wanted to talk to him about how much money--no wealth--his family or even his friends' families had that went waaaay back to, like, I don't know. . .  a time when people worked for free to help with attaining said wealth.

But I didn't.

Instead, I just turned away from him and said, "Hey Marcus! You doin' alright today? I'll have the turkey on wheat--six-inch!"

Because that snort and that smirk were enough for me. Yeah, it was.

Look. I am not trying to get all political on this blog. Not today I'm not. Like him and some others, I make decent money and like keeping my money in my pocket just as much as the next person. And. I'm fortunate enough to have a job with benefits that affords my family health care.


I realize that my position in life is only a little bit hard work and a lot of bit being blessed to be born when and where I was to the parents I have. I think poverty and poor health choices are complicated as hell. Way more complicated than just telling somebody not to get the crispy fried chicken sandwich over the grilled one. Or admonishing them to get water instead of sweet tea.

Look. I'm a Grady doctor. And I know that it isn't as simple as some want to make it. I also know that a whole lot about a whole lot in this country is messed up and unfair.

Messed up. And unfair.

And can I just say that I find this image above both disturbing and disappointing on more levels than I can even begin to impart here? Good, because I do.

So what do I think about all of this, Mr. Upturned-Smirk-on-Your-Face-in-Subway?

I think you and the people holding these signs need to come down to Grady Hospital so that you can meet a few people who tried to make good life choices and got sick anyway.

I also think that next time you order that ham sandwich combo in Subway, you should get the baked Lays instead of the regular ones, the six-inch instead of the twelve-inch, the wheat bread instead of white, and that you should go easy on all that mayonnaise and oil.

You should also hope you never lose that job that your badge indicated you are lucky to have--but if you do--and you keep on ordering like you ordered today in the Subway lunch line--things just might work out in your favor, too.

That's what I think.



  1. Well Said!!! I've got my southern girl conservative views and all, but med school sure has taught me about the human condition. In our overindulged, selfish nation, we should think more about helping our neighbors.

    1. Well said from you, too. "Helping our neighbors" -- that's a good word you just preached. Thanks!

  2. I couldn't love you any more than I already do.
    And that picture makes me both sick and angry. I want to smack those narrow little minds silly. I tell myself that it's fear that's making us so mean and petty, because I need to have an excuse for all this behavior.

  3. You know, I had a couple of mild FB arguments today with my old white boy Atlanta high school pals who claimed we're now on the highway to hell with the ACA upheld by SCOTUS. My reply to him was that my daughter, aged seventeen and severely disabled was going to benefit immediately from that flawed piece of legislation and gazillions of people like her. He shut up.

  4. On my way to work yesterday, my carpool buddy (who was not really happy about the supreme court decision) nailed it. He said that everyone who says that it is a bad law never really tell you what part of it is bad. If you ask them about insuring kids until they are 26, no they are for that. If you ask about no life time or yearly limits, again they are for that. If you ask them about the ban on pre-existing conditions or the insurance companies discontinuing coverage after someone is diagnosed with a catastrophic condition, they are so for that. I think that those of us who have C-class insurance are afraid that the companies we work for are going to quit offering insurance as a benefit and we will be forced to go into insurance pools. The part that bothers me, and I will admit that I don't truly understand it is the Accountable Care Organizations that doctors are supposed to set up. Does that mean that I'm going to be forced to go only to other doctors in that organization? I don't want to leave the specialist that I have had nearly a decade of history with. But if that's what it means and I have to, I'm sure I will adjust. I think that if the government would make more of an effort to help us to understand the law, more people would be for it. I just wish they'd included tort reform in the law.

    1. Hi has a breakdown of the key features of the law, as well as a timeline of any changes that will or have occurred.

    2. Hi Lisa! I'm not everybody, but I can give you some specific reasons that I personally don't like the ACA. I can actually sum it up this way: It's not so much what's IN the ACA that I don't like -- it's what is NOT in the ACA.

      The whole point of the Affordable Care Act is supposed to be to make Care more Affordable for Americans. BUT all it does is expand coverage -- for under-26, through Medicaid, by forcing companies to accept people with preexisting conditions, etc -- WITHOUT providing any substantial reform of the health care system itself. That won't keep health care costs down -- in fact, those changes will increase the burden to the system even more because they are expensive!

      I'm not against any of those specific changes -- far from it! What I AM against is making those changes without making the systemic changes that allow us to pay for them.

      Here are some things that I think make our health care system bulky and expensive:

      - The fee-for-service system. I think this provides a HUGE incentive for doctors and hospitals to order more tests and more treatments than are really necessary. I don't think it's as simple as some people portray it ("Oh, Dr. So-and-So only did that surgery to pay for his Mercades"), but I do think that it contributes in a huge way to the cost of medicine in this day and age.

      - Doctors are paid way too much. Now -- I am a medical student, so I understand that I am shooting myself in the foot here! I understand that doctors incur a LOT of debt in medical school. But the debt is WORTH IT. What other field can you go into that GUARANTEES a six-figure salary? What other field can you go into that GUARANTEES you a job? Those are all great reasons to go into medicine. However, they also add to the burden on the system.

      - The lack of a national records database. I can't tell you how many times I've seen people come into the hospital and get repeat tests that they just got a few days ago, just because the hospital can't get ahold of the patient's records! And I'm just a medical student who has only been in the system a very short while!

      These are a few of the things that I think are REALLY causing health care to become more and more expensive. The thing is -- the ACA does not address ANY of them. It only adds to the burden of debt.

      Those are my two cents and probably WAY more information than you really wanted to know! Thanks for listening and I hope you can see that there are some of us who DO have specific reasons we don't like the ACA.

      Happy Monday and have a great week!

    3. Thanks for sharing. . . really. I am very tempted to counter a lot of this but creating a debate or a big political discussion isn't what I want to do on this blog--although I do admit, I started it! :)I did publish this thoughtful comment because I think it's always important to not just be one-sided.

      We can agree to disagree. I think a lot of folks (not necessarily you) keep talking about cost but not about people. The people that need more NOW are the ones I see. Right now. No matter what, there will be some growing pains. And if it costs me more money and some growing pains to help get people there, I'm okay with that. I don't agree that future patients will lose. I do not. But this is my take on it and I deeply respect yours because it is thoughtful and mindful--not just "better them than me." Unfortunately, a lot of folks sound that way. With this. With Arizona (uggh! did I say that?) With a lot of stuff.

      I like this quote, which I refer to often but particularly as it relates to this topic:

      “For the simplicity on this side of complexity, I wouldn't give you a fig. But for the simplicity on the other side of complexity, for that I would give you anything I have.” ~ Oliver Wendell Holmes, Sr.

      Yes. Yes. And Yes.

      (We can go on all day. . .ha ha ha. . stopping this here.)

      Happy Monday, my spunky medical student! :)

    4. Thank you Dr. Manning! I apologize for hijacking this discussion toward politics a little bit. Sometimes I like the sound of my voice a bit too much, I think -- or maybe "the sight of my text" would be more appropriate in this case :) Sorry!!

    5. Never be sorry--you didn't "hijack" anything. This is a safe place as long as everyone plays nicely. :)

  5. I just love you and your thoughts. Thanks for sharing what you think. :)


    ("Becs" from Live Out Loud, started a new anonymous blog as "Bethany" for a whole multitude of reasons, mainly that apparently I'm too chicken to truly live out loud with some the people in my actual life. Ha.)

    1. Awww. . .hey Becs! I am glad to see you back and look forward to reading your words.

  6. Love this! I hope that the real facts can be shouted from the rooftops to drown out the misinformed. All of us who support this need to learn the facts so that we can combat the folks who take their soundbites from the GOP as the gospel truth.

    1. Jucie, every person is entitled to their opinion. I don't think this is perfect but I do think that something has to give.

  7. Very well-said. Some of us don't realize that we're blessed beyond what we deserve to have what little we have, because there are so many people that are much more worse off.

    1. Yep. Thanks for reading and commenting,Alisa.

  8. The other thing I didn't say Dr. Manning was that my brother-in-law was one of those people who had to quit school at age 14 because of his mother's mental instability so he could make money to feed his younger brother and sister. His mother signed him into the Army at one day after 17 so he'd have a better job and he went to South Vietnam. He was one of those people who never missed a day of work when he had a job. Without an education there was nothing but blue collar, you are expendable jobs available. If he couldn't find a job he collected trash on the street and cleaned gutters and mowed lawns to try to hold it together. Then one day one of his employers wanted to put him through school to get a CLD licence. He jumped. He got the best job he ever had, but it still had no benefits. Ten years later he had a stroke that led to a diagnosis of lung cancer. He died three years later after being treated at Grady. He didn't choose his mother. He didn't choose to leave school in the ninth grade. He didn't choose to serve in the military. He didn't choose to be unemployed when he was. He didn't choose to have lung cancer. Life happened in small steps, a series of events that shaped what choices he had. From what I saw, he truly tried to make the best of it. He was an honorable, if a bit abrasive man. But he was a Grady patient. He loved my sister, and their children, and he did better than his parents. But he wasn't given the best hand in the deal. Still he did his best. Thank you for standing to those who would have disrespected him.

    1. Wow. Your brother sounds like he was really brave. Thank you for sharing, Lisa.

  9. Yes! Thanks for this post. I saw the same picture the other day and it infuriated me.

  10. Dr. Manning - I tried to post a comment earlier and I think it got eaten! So I apologize if I end up commenting twice.

    I LOVE your blog. Every post has something new to teach me about being an effective (future) doctor, a loving person, a good mom . . . the list goes on and on.

    On this one post, though, I have to disagree and stick up a bit for some of us who are AGAINST the Affordable Care Act. I for one am very, very afraid that we are subsidizing the cost of health care for the poor today by sacrificing health care for the poor in the future. I think the idea of expanding Medicaid sounds wonderful in the short run -- but in the long run, it will do more harm than good to the very same people it is supposed to help!

    Health care costs are out of control -- EVERYONE can agree on this point. Unfortunately, other than the insurance mandate (which I don't think does very much at all to keep costs down -- see some of the data coming out of Oregon right now), there isn't a whole lot in the Affordable Care Act that will help to contain this problem. Expanding Medicare comes at a price, and even if it seems like a great thing at the moment, it will quickly become unsustainable if we don't do something NOW to really control costs.

    You can't just wave your hands in the air and go "Poof! Health care for all!" and have it be so -- and be TRULY affordable for all -- without making some very serious structural changes to the system. And as much as I want to expand Medicare coverage, I just can't get behind a piece of legislation that ignores this fact. I know that it is hard to think that way because you deal every day with people NOW who are sick and needy, but I also don't think it is fair or just to prioritize the sick and needy of today over those of tomorrow.

    Having said all of that . . . Dr. Manning, if I can be even half the doctor that you are someday, with a fraction of your compassion and dedication, I will be happy. Thank you for taking the time to keep up with this blog -- you are doing a great service to all us readers.

    1. Anon -- thank you so very much for this thoughtful comment. I am happy to read this logical perspective that, at least, doesn't sound as awful as some others I've heard.

      I'm okay with us disagreeing on this. In fact, I'm proud that you felt comfortable sharing your feelings! This is a place where that is cool, too.

      We can agree that my position has much to do with being in a place every single day where people are sick and needy now. I think there is no perfect way to get there. I don't. But any major overhaul has to be that way--and a lot of unfortunate things are happening now that require us to start somewhere.

      Thank you for your kind words -- I can tell that you already have plenty of compassion!

    2. Thank you Dr. Manning! I wouldn't say that my opinion being "not as awful as others" is exactly a resounding endorsement, but I'll take it :)

      I appreciate you taking the time to listen to me because, to be honest, this post really upset me. I too find the picture you posted to be VERY disturbing -- those people have no understanding of what poverty really is, or all the MANY factors (LUCK being a huge one!) that go into ill health!

      But I also feel like this post paints everyone who is against the legislation with the same brush -- as self-centered people with no compassion or ability to understand the suffering of others. That's pretty upsetting to me and seems awfully unfair. It's hurtful to read a post like this from someone that I respect so much -- a post that is all about how people who serve the poor MUST be for the ACA and those who are against the ACA MUST be greedy corporate jerks.

      Thank you again for taking the time to listen and reply. I know I won't change how you feel about this but I hope you can at least see why this post upset me! Having said that -- there are not many doctors who would take time out of their very busy schedules to respond to an anonymous medical student's thoughts online and I REALLY appreciate you doing so!

    3. Med Student, you are already on your way to being an outstanding physician. Here's why: A huge part of what we do is about making a call, committing to what YOU think after reviewing the data. You clearly sound like someone who isn't a "greedy corporate jerk" and the fact that this position was hurtful to someone like you has given me something to think about.

      I like that you speak up and that you commit to what you believe. Honestly, as physicians we must do that and you will find that many, many times we do not all agree. But, just as when we care for our patients, the key is to keep it respectful and thoughtful--just as you have here. I think I was a bit annoyed when I had that encounter in Subway (note that I wrote it shortly after lunchtime!) so that admittedly peppered the "ummph" behind it. :)

      Wishing you the very best in all that you do--and from reading this blog you should already know by now that I always make time for medical students. . . even anonymous ones.

      Dr. M

  11. I agree with what you say but do not think this health care bill even begins to address the issues for the people that need health care and cannot afford matter how they arrived in that terrible place. In fact, I think it is going to make it harder for them. And I believe if the Congress or the Supreme Court and yes even the President had to live one week in the shoes of those less fortunate things would take a dramatic turn for the better.

    1. The thing is that we have to take a step. I am glad to hear that people are thinking and not just shrugging their shoulders since it isn't them.

      Dang! I wasn't supposed to be getting political, remember?! :)

  12. I am in med school in a country with socialized medicine. Around here, the doctors are appalled when I tell them that millions of Americans lack access to healthcare...they think it's completely primitive. I want to be proud of my country's health care system, believe in its values, its compassion, and its commitment to human decency. Earning less money as a doctor under a reformed health care system is a price I'd much rather pay than the price of working in a system that runs counter to principles I believe in and love.

  13. AMEN.

    "justifying my poor life choices" ***FUME****

    Not to mention all of those CHILDREN with "pre-existing conditions"

    and those people who paid in but used "too much" or became "too sick"

    But for the grace of God go I...

  14. From a girl who grew up on medicaid and food stamps and lots of help from the government....

    I doubt I would be where or who I am today if I didn't get a hand to help me up every now and then.


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