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Orlando Shooter Omar Mateen's Mental Health Likely to Overshadow Gun Control

6/14/2016

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I could talk about the sanctity of queer nightclubs. Queer nightclubs are to queer civil rights as black southern churches are to black civil rights.

I could point out that Donald Trump’s asinine statements about Muslims and a radicalizing second generation are exactly the kind of ignorant bigotry that spurs these sorts of hate crimes to begin with.

I won’t though, because we all know that this has already been done and will continue to be done until this devastating event’s emotional significance is reduced to meaningless babble on repeat.

However, what has yet to come is the inevitable discussion about the mental state of Omar Mateen and the role that might have played in the shooting. Already, there is foreshadowing of this discussion as journalists report those around him describing him as “bipolar” or “erratic.”

I’m nipping it in the bud. We cannot go down that path. It’s distracting and unproductive because mass shootings are not just about mental health. Of course, mental health plays a role, but guess what plays an even larger role? GUNS.
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Liberal and conservative politicians alike focus on mental health as a strategy to avoid discussing the true heart of the gun control debate. 

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Democrats use it to avoid risk. These so-called liberals like to focus on the mental health of the shooters in these high-profile tragedies. By advocating for improved mental health services and preventing the mentally ill from getting guns, they get to seem like they care about gun control without having to actually advocate for any meaningful change.

I’m the main doctor at a primary care clinic based out of an organization that provides psychiatric care and case management for patients with severe mental illness. It’s a population that is very close to my heart. I’ve had patients tell me that they would shoot me given the right circumstances. I understand both the critical shortage of resources for mental health as well as the increased risk that patients that suffer from mental illness have to behave violently.
At the same time, as a family physician I have treated an uncountable number of victims of gun violence. The vast, vast, vast majority of these patients were shot by people who either do not carry a psychiatric diagnosis or whose most serious psychiatric diagnosis is depression.

Addressing gun violence solely through the lens of mental health will never solve the problem. While I’ll be the first to tell you that the woefully underfunded state of mental healthcare is devastating to society on every level, I also believe that it is only a small part of the gun violence issue.

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Provider Resilience while treating the Racially Comatose 

5/19/2016

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One of my favorite parts of being a family med doc is talking with kids. During the routine preventative visits I ask them what they want to be when they grow up, not just as a way to get to know them better, but also to be another small voice telling them that they are worth believing in.
 
Yesterday, the most astonishing thing happened. I asked QiLing, a 7-year-old with bright eyes, that very question and she responded, “I want to teach ignorant people about race so the world will be better for my children.”
 
I told her that she should consider the field of medicine instead because it would be more relaxing and pay more.
 
Right. No one believes that happened.
 
It didn’t happen. Why? Because nobody grows up wanting to be a race educator. Sometimes a child might say they want to fight “bad guys” when they grow up, but not once have I heard any child dream about addressing race inequities.

So it’s shocking to me that some white folks see people of color who do race work as self-promotional. It’s not self-promotion; it’s self-preservation.  We’re forced into this work because we see no other course of action when racism is thrown up in our face constantly.  Back thousands of years ago children did not say to themselves, “I want to be a gatherer!” They just needed food so that’s what they did.
 
But that self-preservation, attempting to address injustice can simultaneously be self-destructive.


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Sexist Southern Sophistry:  Understanding the Texas Abortion Laws and Their Dangerous Implications for All of Medicine

3/6/2016

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​Much like expensive red wines, many Facebook relationships, and Kanye West’s psychological state, the case of Texas House Bill No. 2 is complicated.
 
Last week the Supreme Court heard oral arguments for Whole Woman’s Health v Hellerstedt, one of the most pivotal cases in abortion law in decades. The plaintiff seeks to strike down Texas House Bill No 2, commonly referred to as HB2, legislation that was passed in 2013.  It’s legislation that, under the guise of protecting the health of Texan women, has actually endangered their well being by restricting access to abortion services in Texas.
 
It will set a dangerous legal precedent if found constitutional. Not only will it impact abortion access, it could change the way we practice all of medicine.
Picturecredit: me
HB2 is the most medically intrusive legislation that has ever been written. It placed several restrictions:
  • Limits the gestational age of procedures to 21 weeks
  • Requires that abortion centers must meet the standards of ambulatory surgical centers
  • Requires that all abortion providers must have admitting privileges at a local hospital
  • Requires that the medications that are used for medical abortion are given exactly as the FDA approved
 
HB2 is like Mylie Cyrus talking about race in America. At first blush her statements don’t seem completely unreasonable, but then you realize that she’s simply hiding her own sanctioning of a racist musical industry underneath a thin veneer of false caring, rainbows, and appropriated yoga mantras.
 
Similar nonsense is generated when legislators regulate abortion. The areas of expertise that legislators have are writing rambling documents, shaking hands, and distributing little signs with their names on them. Nowhere in that list is medical care. HB2 is an attack on the rights of women under a thin veneer of false caring and flawed medical reasoning.
 
Supporters of HB2 say it’s meant to protect the well being of women, but the language of the bill demonstrates its true intent. The number of times the bill uses the word fetus, zygote, or embryo? Zero. The number of times it uses the phrase “unborn child” or “unborn children?” Twenty-seven. The number of times I heard a lecturer in medical school say the phrase “unborn child/ren?” Zero. The number of times I heard a lecturer in medical school say fetus, zygote, or embryo? Countless.
 
Furthermore, it is an attack on every American’s right to high quality healthcare.
 
Nowhere else in medicine are doctors told by the law how exactly how to practice in such detail, for good reason.  Certainly there are quality measures that must be met such as standards around sterility, safety, and first aid, but there are no laws that get into the minutiae of when and how to prescribe a medication. Even when it comes to potentially lethal controlled substances such as methadone, the details of dose and timing is left up to a provider’s judgement.


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Peter Liang Highlights the Asian American Identity Crisis 

2/28/2016

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PictureThis. Is. Nonsense.
The conviction of Peter Liang is the best thing that has happened to Asian Americans since the Immigration and Nationality Act of the 1960s. It’s also an embarrassingly example of how bewildered the minds of some Asian Americans are when it comes to race.
 
The conviction is a much-needed wake up call to those who have been brainwashed to believe the model minority myth. It’s clear evidence that white America still views Asian Americans as “other.” The “Blue wall of silence” does not cover yellow.
 
Peter Liang’s conviction makes painfully obvious three crucial facts that are necessary to understand the racial circumstances of Asian Americans. (1) American racism includes Asian Americans. (2) Through intentional legislation and campaigning, the white majority has utilized the educational and financial privilege of a portion of Asian Americans to convince society that racism is no longer an issue. (3) Asian Americans themselves have fallen prey to this message, driving a wedge between the Asian American community and other communities of color and weakening our collective power to change the status quo.
 
The model minority myth has led much of America to believe that through hard work and an unwavering dedication to academic achievement, Asian Americans have achieved the true American dream, supposedly showing that it is not systemic racism but lack of adherence to American work ethic that holds back other communities of color.
 
While the falsehoods that make up the model minority stereotype and its toxic impacts are too complex and numerous to unpack in their entirety here, exploring a few the issues is necessary.  A key misunderstanding is the origin of stereotypes. While most of us recognize that stereotypes are generalizations that cannot be applied to any one individual, we also believe that they spring from a small grain of truth.  They represent a generalization of a true trend in behavior or characteristic that is common amongst a group of people.
 
What this line of reasoning fails to capture is that frequently these behavioral trends are not inherent, but a group of people all responding to a uniform external pressure. For example, the disproportionate number of black athletes in the NBA does not represent an inherent racial ability anymore than the disproportionate number of white athletes in the NHL does. It’s a reflection of the networks and opportunities available to black males in this country. Under the same social restrictions, many black men come to the same conclusion: the only way to make it is to become a professional athlete and the only sports available are basketball and football.


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Mumia highlights the poor state of correctional health and need for pay-for-performance

1/24/2016

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​Physicians are held to professional expectations dictating that the failure to provide standard healthcare is malpractice.  There is no difference between failing to provide a service and performing a liable medical mistake.
 
A recent study revealed that out of the top three reasons why OBGYN physicians are sued for malpractice, two of them are related to inaction: 1) delays in intervention when there are signs of fetal distress and 2) the improper management of pregnancy including failing to test for fetal abnormalities when indicated, failure to address complications of pregnancy, and the failure to address abnormal findings.  As a family medicine physician, I have been warned countless of times that one of the most common lawsuits relates to not identifying cases of skin cancer. In each of the instances, an inaction that results in a patient not receiving standard care is considered malpractice.
 
Given that not providing standard of care is malpractice, Mumia has been a victim of malpractice at the hands of the prison health system in two major areas:
  • Even though Hepatitis C treatment is not always required, the failure to provide it for Mr. Abu-Jamal would be medical negligence. By even the most conservative standards, he meets criteria for treatment.
  • Failing to treat his elevated blood sugars until he was unconscious is clear malpractice and gross negligence.
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Unfortunately, Mr. Abu-Jamal’s case is not an isolated incident. Across the country inmates are not only being denied necessary Hepatitis C treatment, but they are also being denied other basic healthcare needs. 
A four part article:
  • Hepatitis C treatment denial would be second death sentence
  • Diabetes ignored
  • Nationwide privatization of correctional health and malpractice
  • Pay-For-Performance necessary for sustained quality improvement

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Imposter, MD

7/18/2012

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Last week I began functioning as a real doctor.  I didn’t wear a long white coat because family medicine doctors are too counter-culture to wear white coats but, I did write a prescription without having to run around looking for a doctor's signature.  I filled out official medical paperwork and signed "MD" behind my name. When my patient addressed me as, “doctor” instead of babbling out the usual, “No, no. I’m a medical student, but perhaps I can still be of help. If not, I’m certain I can find someone who can,” I simply turned and said, “Yes?”

As excited as I am to be moving forward in my training, and as sure as I am that I learned many useful things over the past four years of medical school, I can't shake the feeling that when I say I'm a doctor, people have an image of what that means that is different from what I actually am.  As my co-intern said the other night at happy hour, "Is anybody else suffering from intense imposter syndrome?" Unanimous nods.

Acknowledging it out loud helped explain the thoughts that had been popping into my head the past few weeks.  Whenever I had a moment of downtime, memories that I hadn't thought about in years would seemingly randomly surface: the time that a friend in high school decided she didn't like me anymore and I never understood why or what I had done; the time at soccer practice when I was nine and I was chided for thinking I was better than my teammates; and the time a coworker told me that he didn't trust me.

What I fear is that somehow I've gotten this far despite of who I am. The litany of remembered failures and shortcomings, however small, are moments when people were able to see through to the truth of me. At any moment the smoke will clear and everyone around me will be able to see what they saw as well.  One ought to chastise me for even entertaining the thought that the people are around me could be so obtuse for so long, but the quiet fear remains, lurking in the back ground of my thoughts.


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Graduation Speech!! Ren Ai: the Consistency of Being Kind

5/14/2012

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Hey folks! For those of you who are curious, I've posted the speech that I gave at graduation this past Friday. It was a huge honor to be chosen by my classmates.  I've also included the text here.
jessica_guh_graduation_speech_2012.pdf
File Size: 53 kb
File Type: pdf
Download File

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Remembering to Bask

4/7/2012

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Sad but true: I’m not very good at writing about happy things.  In fact, now that I think about it, I’m not very good at celebrating.

Celebrating is not to be confused with partying.  I like parties.  I like laughing and being loud with friends.  I like getting carried away into the night.  Partying frequently happens in the setting of celebrating something so it’s never occurred to me that I might be bad at celebrating, but I am. It’s partying that I’m good at.

Partying can be mindless, but celebration requires a sincere appreciation of something positive.
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This is my dog. She is celebrating the birth of Jesus.
Maybe it’s having high expectations for oneself gone too far.  When I think back to many of the accomplishments that I’ve been supposed to celebrate for myself, they don’t tend to move me.  Usually they’re related to studying hard, working hard, or training hard.  These are all tithme consuming things that can be unpleasant at times, but ultimately they are just that -- time consuming and sometimes tedious.

Or maybe it’s because that I’m so aware of my own privilege that these accomplishments are not as impressive as they may seem.  There were not necessarily that many obstacles in front of me.  What is so special about simply doing the work that was put before me? Conversely there’s an important distinction between humility and taking ones accomplishments for granted.

However, regardless of ones reasons for not truly celebrating, I’m realizing that celebration is important when it comes to sustaining oneself.  The victories are few and far between and the disappointments seemingly unfixable.

Recently my classmates elected me class speaker. It’s flattering, an honor, and most of all, a surprise.  So often I feel isolated and not just ignored but brushed off.  Getting elected to speak at graduation by my peers does not align with my own impression of how my classmates see me.

At some of my lowest points those around me often remind that the silent masses are not necessarily in disagreement.  Sometimes people are scared to speak up; sometimes it’s not in their personality; and sometimes they think that since I’ve already said it, what point is there in saying anything? I shouldn’t assume that everyone thinks I’m unreasonable.

I should celebrate this.  Not just as a personal achievement, but as something positive that I need to embrace because how often is the dissenting opinion voted to give a speech?  The world does not dole out affirmations.  Strength, just like self-confidence is something that must come from within us.  But, in those moments of weakness and doubt, why not take advantage of the few external validators that come your way?

And so I will celebrate. Not with partying, but with a little meditation.  I will sit and bask in the positivity, the way one basks on the beach hoping to store some away for the coming winter.
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Freedom from Self-Loathing: even better than getting to pee after holding it for a long time

3/12/2012

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I’m frustrated.  The man sitting in front of me is an incredible person. He’s been the chair of medical departments and president of one of the world’s largest global health non-profits. He’s improved the lives of millions of people. I have everything to learn from him, but I can’t seem to get much from what he’s saying.

It’s hard to pin him down. He is willing to condemn fee-for-service reimbursement and endorse an accountable care organization model but the conversation stops there.  He doesn’t even give me a chance to finish asking about his thoughts on single payer; he talks right over me.  He’s most famous for both working in the pharmaceutical industry and also being a champion of increased access to medicines. When I ask him how he personally navigates the tension between the “incentive for innovation” and increasing access to medications worldwide, he describes the financial strategy of providing funding to help defray cost and risk to pharmaceutical companies, but there is no mention of his own inner, ethical dialogue.

This is my chance to take advantage of the “old boys’ club” network and I feel it being schmoozed and side-stepped away with tangentially related anecdotes.

I get the distinct feeling that this is how it feels to be a member of the press interviewing a politician and that confuses me even more because the context of our conversation is not an antagonistic one.  We were invited to chat with him over a meal so that we could learn from him -- we were even asked to submit questions ahead of time!

I’m also pretty sure that he doesn’t like me.

Dammit. How depressing. I can’t even make friends when I want to.

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Occupy Hyatt

11/27/2011

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Lorena Reyes empowers herself by re-presenting the original image
The mainstream media likes to claim that Occupy Movement is comprised of aimless activists without concrete goals. They should go ask Martha and Lorena Reyes, two recently fired Hyatt housekeepers who know exactly why the 1% who run everything need to be occupied and what the 99% is demanding.

Until recently, the two sisters worked for the Hyatt Regency in Santa Clara, CA. On October 14th, after 30 years of combined service, they were abruptly fired.

According to the Hyatt, they were terminated for “stealing company time.” The hotel alleges that they took ten minutes too long on their lunch breaks.  The Reyes sisters explain that housekeepers are assigned so much work that they frequently do not have time to take their legally-mandated, 10-minute break in the morning. It is routine and long-accepted by management for them and their coworkers to take an extra ten minutes during lunch to replace their missed break.

The Reyes sisters believe that they were actually fired for a different reason. 

Their story begins in September during “Housekeeping Appreciation Week.” On arrival to work, Martha was greeted with a collage of her and her coworkers’ faces digitally altered onto the bodies of women in bikinis. She was horrified and took down the picture of herself and her sister, Lorena.

Though it’s commonplace to see images of scantily clad women in the media, Lorena explains, “In my culture I was raised to be conservative with my body. I don’t like bikinis…  I felt very uncomfortable knowing my male coworkers were looking at that.”

Shortly afterwards, both women were fired.


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    What I've been reading:

    The Dark Forest (Remembrance of Earth's Past #2)
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    by Liu Cixin

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    about this blog

    A place where I can write my thoughts on race, on privilege, on class, on being a doctor. Part of the endless struggle to become a little bit more enlightened and feel a little less alienated.

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    I post once or twice a month with smaller comments on mini-blog.

    about me

    My name is Jess. In the interest of full disclosure: I'm a 30-something-year-old Chinese American and believer that the quest for social justice and equity must be an intentional and active one. I'm a Family Medicine physician. I'm queer. I'm a radical. I grew up in a mostly white suburb and my parents are white-collar workers.  And I don't eat meat, but I miss it sometimes.

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