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Coping with Orlando

6/16/2016

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It's been difficult to know how to cope with the mass murder in Orlando. It's an amalgamation of emotion:
Personal safety as a queer person. Heartbreaking loss of human life. Frustration and anger around the politicking and continued lack of gun control. I go to conferences all over the country all the time. I go to a gay club in every city. I was just in Orlando! It triggers all the emotions that surface when abortion clinics, another issue close to my heart, are targeted with violence.

As I imagined the victims, other queer people of color, I reflect on the compounding difficulties of being a minority within a minority.

Today I've found some comfort by celebrating the amazing QPOC culture. What straight people don't understand is how important gay clubs are. Movies and TV portray it as a social gathering place at best and sex craved debauchery at worst - but it's so much more than that. The community that is formed; the self-actualization and validation that is often found nowhere else; the political organizing. When I think of gay clubs I think of empowering warmth (except when it's dominated by all white people, then sometimes I feel angry). And so naturally I could not help but think about Voguing.

This, of course, triggered a whole new group of cascading emotions. I felt proud of the culture that Voguing created. But I also felt sadness that such a vibrant community come under attack. I felt anger at the way that Voguing has been appropriated.

Straight folks just don't get it.  Even wikipedia, my trusted source and salvation during medical school, doesn't capture the emotional and communal importance of Voguing in their article.  Nor does it discuss how artists like Madonna and documentary artist, Jennie Livingston, have benefited from Voguing as its not clear what trickle down benefits the original communities experienced.

That being said, overall, as I watch some of my favorite Voguing videos on YouTube, I feel inspired and somehow calmed. It reminds me of the strength of our community and that even in the bleakest of times, we will rise again and celebrate ourselves. And mostly I feel gratitude that the generations, specifically in this case black and latino POCs, that have come before me (who have faced so much more than I have personally as a QPOC) have role-modeled such courage and beauty.
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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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Healthcare is Politics #yellowperilsupportsblackpower

5/22/2016

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Hey y'all. As we all know, access to the healthcare system only impacts the health of our patients by, like, 20%, if that. What really impacts health outcomes are education, housing, food security, and, well, not getting shot. If you care about health, you need to care about politics.
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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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Zika Hysteria Spreading Faster than Zika Itself

5/13/2016

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Zika has been described as extraordinary in so many ways. But the only thing that’s really extraordinary about the whole thing is how incredibly dispassionate I am about it.

At this point, even extraterrestrials have probably heard that the World Health Organization declared the recent spread of the Zika virus an international public health emergency. That sounds pretty scary. It’s only the fourth time that the WHO has ever declared a PHEIC (Public Health Emergency of International Concern) so it seems like it ought to be a big deal.

However, it’s important to keep things in perspective. As of May 4, there were 1,278 confirmed cases of microcephaly, the birth defect linked to Zika virus infection that causes an abnormally small head and brain. There are approximately 250 suspected neonatal and fetal deaths. In comparison, the last PHEIC was the Ebola virus outbreak of 2014. The current total number of reported cases of Ebola is 28,616 causing 11,310 deaths. Finally, the WHO estimates that the annual run-of-the-mill flu season –not famous epidemics like the Swine Flu – causes 250,000 to 500,000 deaths every year around the world.
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credit: me
I understand how Zika tugs on our heartstrings. Babies are precious, innocent, and full of potential. But I would like to point out that children are also precious and worth protecting and I have yet to see a media blitz or public outcry as passionate for the over 300,000 children who suffer from physical abuse every year in the United States alone

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Change to the "Abortion Pill" Overrated: FDA approval of the new mifepristone label is only a band-aid

4/3/2016

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Women’s health advocates were uniformly jubilant on March 30, 2016 when the FDA updated its labeling for the medication, mifepristone. Mifepristone, sold under the brand name Mifeprex by Danco Laboratories, is commonly referred to as “the abortion pill.” It is used in combination in the United States with misoprostol to provide medical abortions. Medical abortions account for nearly a quarter of all abortions and over a third of all abortions before nine weeks of gestation.

Raegan McDonald-Mosley the chief medical office of Planned Parenthood described the change as “a significant step forward for science, for women, and for health care providers.” Vick Saporta, the president of the National Abortion Federation said that she was “delighted” by the change. Amy Hagstrom Miller, the president of Whole Women’s Health, the plaintiff in the case against Texas HB2, stated “[the] label change…is a significant advancement for women in the United States.”

Their elation is understandable. In an era of illegal and misleading smear campaigns and aggressive TRAP laws (“Targeted Regulation of Abortion Providers"), the FDA announcement is a welcome victory. Since 2010, states have adopted 345 abortion restrictions, an unprecedented number of assaults on women’s health.

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While celebrating small victories is an important practice for emotional well being, it’s also imperative that we keep a broader perspective. This is just a small Band-Aid. Taylor Swift has never been so wise as when she reminded us that Band-Aids don’t fix bullet holes.

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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.
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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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Ted talk here I come! Talking about the Model Minority Myth

2/25/2016

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One day we'll do an animated version, but until then, powerpoint and prezi is where it's at...
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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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    about this blog

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    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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