Surgeon’s Death Spurs Painful Debate On Docs As ‘Face Of Health Care System’

Flowers are left outside the Brigham in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Flowers are left outside the Brigham last week in honor of the slain Dr. Michael Davidson. (Robin Lubbock/WBUR)

Shocked and saddened by last week’s shooting at Brigham and Women’s Hospital, Dr. Miranda Fielding wrote a blog post that appeared on KevinMD, a popular site that gets 5 million clicks a month: “The Legacy of Dr. Michael Davidson.”

KevinMD, as founder Dr. Kevin Pho puts it, aims “to share the stories of the many who intersect with our health care system, but are rarely heard from,” including practicing physicians. He adds: “The public often doesn’t know what it’s like to work in our health system. gives them an unfiltered view of our world.”

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

Dr. Michael Davidson (Courtesy of Brigham and Women’s Hospital)

In the case of Dr. Fielding’s post, that unfiltered view reveals not only deep pain at a distinguished colleague’s death but also a far broader discomfort with serving, as one commenter puts it, as “the face of the health care system” — a system that sometimes harms patients, medically or financially.

In her post, Miranda Fielding — the pen name of a California-based radiation oncologist who blogs at The Crab Diaries — recalls from her own professional past a gentle colleague who was viciously beaten by a former patient, and writes:

When we graduate from medical school, we take the Hippocratic Oath, which in the modern version not only exhorts us to heal the sick, but to exhibit warmth, sympathy, and understanding. Let our patients and their families extend those same traits to us as we complete our daily rounds. Let our clinics and hospitals be places of healing, and not of killing. Please let us do our jobs.

I only wish that I had the answers to the groundswell of anger, frustration and resentment voiced in the comments on my blog.

– Dr. Miranda Fielding

Her post has been shared on Facebook more than 40,000 times, and sparked more than 150 comments. The post, Dr. Pho emailed, “clearly touched a nerve with my audience and highlights the sacrifice that health professionals make every day.”

But the response to the post highlights more systemic issues as well. Among the comments, the most popular, by a writer identified only as “guest,” refers in part to the report that the alleged Brigham shooter had complained in the past about a medical bill for the heart attack that killed his father:

What we as a profession appear to be (willfully) unaware of is that we doctors are the face of the healthcare system. To the extent that we do not speak up, protest and advocate for our patients when they are taken advantage of by hospitals and insurers, we provide a face for patients to blame. Anyone who doesn’t think that corporate executives and hospital administrators take full advantage of the opportunity to hide behind us as they maximize profits at the expense of our patients, is a fool.

We may think that because we go through our days bathed in an aura of self-righteous goodness (Look how we’re the smartest person in the room! How hard we work! How little sleep we get! How many of our child’s soccer games we’ve missed in order to care for our patients! How we do all this without even mentioning it to our patients, because that’s how good we are!), that that is how our patients see us as well.

But they don’t. They see the fancy cars in the parking lot, the children going to elite prep schools, the expensive hobbies like equestrianism, the hospital system charging $8,000 for a 15 minute emergency room visit that ended in death, the collection agency coming after a grieving family. And they blame us for not doing more.

Responded another commenter:

This is a horrible tragedy for all involved — him, his family, friends, colleagues and his other patients. And for other docs out there who are now more afraid. My heart aches for the victim of this violence and for all of us.

But you’re right. This did not happen in a vacuum. Continue reading

Bullying Is Ageless: Conflict And Violence Widespread In Nursing Homes, Study Finds

Ulrich Joho/flickr

Ulrich Joho/flickr

By Nell Lake
Guest Contributor

For Eileen, who is disabled and reliant on a wheelchair to get around, life in a nursing home isn’t easy. Particularly when it comes to the other residents: “There’s this guy,” she says. “He made advances to me all the time. I did not want his advances. Many times I had to take my grabber and actually strike him to get him to leave me alone.” Another resident, Eileen says, is a “real bully. She has terrorized quite a few people. She tries to boss people around. She says harassing things.”

In coping with this type of hostile behavior, Eileen (who asked not to be identified) has plenty of company. New research released last week shows that aggression among residents in nursing homes is widespread and “extremely high rates of conflict and violence” are common, according to study author Karl Pillemer, professor of gerontology in medicine at Weill Cornell College of Medicine in New York. His stark findings, presented at the annual meeting of the Gerontological Society of America: One in five people living in the nursing facilities studied was involved in at least one “negative and aggressive encounter” with another resident during a four-week period.

“In most environments — say my work environment at a university — someone yelling at me angrily is so unusual that it would keep me up all night worrying about it,” Pillemer says. Yet such conflict in nursing homes appears to be routine.

Abuse and Mistreatment

As part of the study, researchers examined patient records at ten nursing homes in New York state, interviewed staff and residents, and recorded incidents through direct observation. In a sample of more than 2,000 residents, 16 percent were involved in incidents of cursing, screaming, or yelling; about 6 percent in physical violence such as hitting, kicking, or biting; one percent in “sexual incidents, such as exposing one’s genitals, touching other residents, or attempting to gain sexual favors”; and 10.5 percent in events researchers labeled “other” — residents entering rooms uninvited, for example, or rummaging through others’ belongings. Continue reading

Study: Teen Girls Who Exercise Have Lower Risk Of Violent Behavior

A few years back, an acquaintance told me that one of the few mandates he imposed on his daughter was that she play a sport regularly, whether she liked it or not. At the time, I thought it was a bit harsh. But now, with a ‘tween daughter of my own who is happiest curled up on a comfy chair reading, and sometimes needs a nudge to run around, I totally get it.

Girls need to move for so many reasons, among them, mental clarity, physical fitness and confidence, and simply to learn that their own bodies can bring them immense joy. Now, add another benefit to the list: it keeps them out of trouble.

(Rohan Reid/flickr)

(Rohan Reid/flickr)

Researchers from Columbia University in New York report that teenage girls from inner-city neighborhoods who exercised regularly were less likely to carry a gun and engage in violent behavior and activities.

Here are some of the findings, from the Columbia news release:

–Females who exercised more than 10 days in the last month had decreased odds of being in a gang.
–Those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang.
–Females reporting running more than 20 minutes the last time they ran had decreased odds of carrying a weapon.
–Those who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight or being in a gang.
Continue reading

Don’t Blame Autism For Violence, Advocates Say

By Karen Weintraub
Guest Contributor

Within hours of the Newtown school massacre Friday, media outlets such as Fox began reporting that the young man police identified as the shooter — Adam Lanza — had an autism spectrum disorder. They said their information came from a comment Lanza’s brother, Ryan, made to law enforcement officials, as well as suggestions from family friends and acquaintances.

Several reporters referred to Lanza’s autism as fact and in the same breath, they mentioned his alleged atrocities – leaving the impression that one had led to the other.

The autism community reacted with horror to that suggestion. advocates took to the Internet to express concern about the way the media was portraying Lanza and autism. Several blogs appeared and were widely shared, including Slate’s Emily Willingham, who explained that just because people with Asperger’s have trouble reading other people’s emotional cues doesn’t mean they don’t have empathy – and certainly doesn’t make them more inclined toward violence. Ron Fournier of National Journal also wrote a widely circulated piece urging readers not to stigmatize those with Asperger’s, like his son Tyler, 15.


Tweets abounded in response to the suggestion that there was somehow a link between autism and the elementary school tragedy:

“I’ve been lucky to work with some VERY wonderful people with autism. Don’t stereotype, please,” one said. “Would be a huge blow to the wonderful Autism community that has come so far if in fact Lanza was on the spectrum…” noted another.

“We don’t believe that it was the autism that caused this act to occur,” said Peter Bell, executive vice president of Autism Speaks, an advocacy group. “It is not part of the definition of autism.”

There is no link between autism and violence against others. Studies show that anyone with a disability is far more likely to be the victim of a crime than the perpetrator of one, and nearly half of teenagers on the spectrum have reportedly been the victim of bullying.

“We need to remember that in the aftermath of horrifying tragedies like this, for fear of adding to the stereotypes and prejudice that Autistic people and others with disabilities already face,” said Ari Ne’eman, president of the Autistic Self Advocacy Network, a group of adults who identify themselves as having an autism spectrum diagnosis. Continue reading

Harvard Psychiatrist: Don’t Draft Children To Fight School Shooters

Connecticut State Police lead children from the Sandy Hook Elementary School in Newtown, Conn., following a reported shooting there Friday, Dec. 14, 2012. (AP Photo/Newtown Bee, Shannon Hicks)

Connecticut State Police lead children from the Sandy Hook Elementary School in Newtown, Conn., following a reported shooting there Friday, Dec. 14, 2012. (AP Photo/Newtown Bee, Shannon Hicks)

A double public-engagement thank you to Dr. Nancy Rappaport, the director of school-based programs at Cambridge Health Alliance and an associate professor of psychiatry at Harvard Medical School. She shared valuable expert advice about post-shooting anxiety on the parenting blog of The New York Times this weekend, including the comforting thought that many children may simply take the bad news in stride. And below, she shares her warning that “ALICE,” a strategy that drafts children into counter-attacks on school shooters, is not worth the risk.

By Dr. Nancy Rappaport
Guest contributor

In Friday’s news reports on the horrendous school shooting in Connecticut, the widely circulated photograph of children being led to safety by adults struck me. In it, students — understandably visibly upset — are evacuated in a line, hands on each other’s shoulders, and moving under the direction and supervision of trained adults.

Imagine, in all unlikeliness, the worst.

An armed gunman. Your children’s school. As a parent, your panic and anxiety are at unprecedented levels. Are your kids safe? Who’s responding to the situation? What’s happening?

Dr. Nancy Rappaport

Dr. Nancy Rappaport

Now imagine the students at your kids’ school actively engaging and interacting with the gunman — throwing objects, trying to confuse him, being assertive and putting themselves even more in the line of danger. Would you want your kids — even as young as kindergarten age — manning the frontlines during an attack?

This practice is known as ALICE — alert, lockdown, inform, counter, evacuate — and according to a recent article in the Boston Globe, more than 300 schools around the country have adopted its risky procedures, which include training children to intervene and participate in the event of a school shooting.

Conducting safety assessments is one of the critical components of my role as director of school-based programs for Cambridge Health Alliance. I advise administrative school officials and school districts on whether behaviorally challenged students are safety threats to others. As a psychiatrist and someone whose role is centered on the protection and best interests of students and schools, I am strongly against ALICE. Continue reading

CDC: Sexual Violence Linked To Health Problems

Buried in the CDC’s startling and depressing report yesterday on sexual violence in the U.S. was the fact that such trauma can also lead to varying illnesses and health problems.

The AP reports:

Both men and women who had been menaced or attacked in these ways reported more health problems. Female victims, in particular, had significantly higher rates of irritable bowel syndrome, asthma, frequent headaches and difficulty sleeping.

Here are the some of the other key findings, according to the CDC news release:

For women:

–High rates of sexual violence, stalking, and intimate partner violence were reported by women.
–Nearly 1 in 5 women has been raped at some time in her life.
–One in 4 women has been a victim of severe physical violence by an intimate partner in her lifetime.
–One in 6 women has experienced stalking victimization during her lifetime in which she felt very fearful or believed that she or someone close to her would be harmed or killed. Much of stalking victimization was facilitated by technology, such as unwanted phone calls and text messages. Continue reading