Monday, November 7, 2011
Thursday, September 22, 2011
RE: NY Times article, 9-19-11 “Retiree Benefits for the Military Could Face Cuts"
The proposal to "cut" and postpone military retiree pensions and health benefits as reported in the NY Times is one solution to fiscally imposed difficult choices.
What is most notable is the emotional outrage expressed in the quotation referring to the current system; “It cries out for some rationalization...Why should we ask somebody to sustain a system that’s unfair by any other measure in our society?”
Unfair? To whom? Fair by "every other measure"? Are we measuring apples and oranges when we compare the cost of annual health insurance premiums for military personnel and their families with that of civilians?
“The fact that you are getting out of Iraq and Afghanistan does make it easier,”
Really?
The piece also states that the current price of military retirement may begin to interfere with military capability. The question is- can we afford military defense of this country?
How many civilians give up so much of their health as do military personnel? Do our families sacrifice as much time together, hardship making it on our own for extended periods of time, and based on well-publicized studies, the children of deployed military endure increased rates of psychiatric illness relative to their civilian counterparts.
I am one of those civilians, but I have spent one-half of my time during the last half of my medical career, attending either veterans or active duty personnel returning from Iraq and Afghanistan. I saw 2 young female veterans of the Persian Gulf War return to the same clinic, one needing a lung transplant, and the other a heart transplant. An active duty infantry officer with 3.5 years of combat experience, of which eighteen months were served contiguously in Iraq, was treated for an incipient myocardial infarction two years later at age 37. His son, age 25 months upon his father’s return from Iraq could not bear to let go of his father for the next 8 months.
Every day I saw veterans and active duty personnel with serious medical conditions related to the abuse their bodies suffered due to service. In this population, to have knees and backs escape painful dysfunction until the same age as the average civilian is a rarity in my experience with this group.
And of course, as is so commonly mentioned in the press, there is the post-traumatic re-experiencing of the horror of war, day and night, for the rest of their lives.
Perhaps the current context IS the most troubling of circumstances. The January 2011 issue of The Veterans Post News reported that $9 billion received by the Department of Defense from the sale of Iraqi oil “and other revenue streams vanished” with 8.7 billion of the funds unaccounted for, according to the online inspector general’s report.
Is it fair to cut the benefits of those who give up and suffer so much, who are paid so little for their sacrifice? Is out-of-sight, out-of-mind a justifiable rationale for this amputation of benefits? Can the civilian sector afford this particular tragic choice?
Those who would answer affirmatively are predictably not those who have served, nor their relatives, friends, health care providers. They know the lack of proportionality in self-investment by those in uniform who serve the rest of us.
Monday, September 19, 2011
Is This Benefit Amputation Affordable?
RE: NY Times article, 9-19-11 “Retiree Benefits for the Military Could Face Cuts"
The proposal to "cut" and postpone military retiree pensions and health benefits as reported in the NY Times is one solution to fiscally imposed difficult choices.
What is most notable is the emotional outrage expressed in the quotation referring to the current system; “It cries out for some rationalization...Why should we ask somebody to sustain a system that’s unfair by any other measure in our society?”
Unfair? To whom? Fair by "every other measure"? Are we measuring apples and oranges when we compare the cost of annual health insurance premiums for military personnel and their families with that of civilians?
“The fact that you are getting out of Iraq and Afghanistan does make it easier,”
Really?
The piece also states that the current price of military retirement may begin to interfere with military capability. The question seems to be, can we afford military defense of this country?
How many civilians give up so much of their health as do military? Do our families sacrifice as much time together, hardship making it on our own for extended periods of time, and based on well-publicized studies, the children of deployed military endure increased rates of psychiatric illness relative to their civilian counterparts.
I am one of those civilians, but I have spent one-half of my time during the last half of my medical career, attending either veterans or active duty personnel returning from Iraq and Afghanistan. I saw 2 young female veterans of the Persian Gulf War return to the same clinic, one needing a lung transplant, and the other, a heart transplant. An active duty infantry officer with 3.5 years of combat experience, of which eighteen months were served contiguously in Iraq, was treated for an incipient myocardial infarction two years later at age 37. His son, age 25 months upon his father’s return from Iraq could not bear to let go of his father for the next 8 months.
Every day I saw veterans and active duty personnel with serious medical conditions related to the abuse their bodies suffer due to service. In this population, to have knees and backs escape painful dysfunction to the same age as the average civilian is a rarity in my experience with this group.
And of course, as is so commonly mentioned in the press, there is the post-traumatic lifetime re-experiencing of the horror of war, day and night, for the rest of their lives.
Perhaps the current context IS the most troubling of circumstances. The January 2011 issue of The Veterans Post News reported that "$9 billion received by the Department of Defense from the sale of Iraqi oil and other revenue streams vanished” with 8.7 billion of the funds unaccounted for according to the online inspector general’s report.
Is it fair to cut the benefits of those who give up and suffer so much, who are paid so little? Is out-of-sight, out-of-mind a justifiable rationale for this amputation of benefits? Can the civilian sector afford this particular tragic choice?
Those who would answer affirmatively are predictably not those who have served, nor their relatives, friends, health care providers. They know the lack of proportionality in self-investment by those in uniform who serve the rest of us.
Tuesday, September 13, 2011
Ethics in today's world. Does it have a place? If so, where? If not, what awaits in the world of the future?
Today in the NY Times, columnist David Brooks bravely and astutely chronicles the results of a sociological study, exploring the state of moral understanding and reasoning of current youth. The casual brush-off of any basis in reality of moral truths, standards, or authority is fairly pervasive on turf beyond the 18- to 23-year-old set and has been for a couple of decades in some circles.
Having served on numerous medical ethics boards, I was often informed by other members during ethical debate, "Don't you know the old ethics is gone, dead, no more!" This outlook is a reflection of the cultural change highlighted by Mr. Brooks. Having taught medical ethics in medical schools, I recall students on several occasions, instructing the instructor, "Don't bother me with ethics.... just tell me what the law says... that's all I'm interested in."
I have reminded them that at the Nuremberg trial, no Nazi physician thought he had done anything unethical--- because the action was legal. This reminds us that we ignore some moral and ethical consensus at our own and others' peril.
The wisdom of ethics deliberative bodies rests on the various perspectives brought by individuals with a range of past histories, traditions, and training with good faith interest and commitment to arriving at the best decision for those with a stake in the outcome. These differences enrich the fabric of ethical discourse when there are some fundamental shared common values. For example, if life has no prima facie intrinsic worth, any discussion about courses of actions that affect lives becomes irrelevant. Ethics and morality are anchored in the community and not the individual, although the moral agent is often the individual. Albeit an ascendant value amongst contemporary ethical principles, autonomy that becomes radical and unyielding to community no matter the circumstance surely ushers our future world back to the Dark Ages.
David Brooks' alert merits consideration during decision-making by those entrusted with mentoring our youth. If parents, educators, policy-makers, and other societal principals have no shared prima facie values, it is unlikely that a new generation will embrace "ought", (i.e. “I accept some personal responsibility for my actions and life as it relates to others.”) in favor of "have to" (e.g. “Someone else has taken responsibility for enforcing choices I make.”). Moreover, the slippery slope ultimately erodes the underlying premise of law as well.
Thursday, August 25, 2011
New Book Publication
Preview of Give and Take: A Roadmap to Understanding a Psychiatrist, now available at B&N, amazon.com, and iUniverse.com:
No one plans to be uncomfortable, ill, or emotionally and physiologically exhausted— it arrives unannounced, stealthily, much like an ambush that interrupts one's focus elsewhere. Adding to this confusion is the fact that psychiatric symptoms may appear in someone who has been a high achiever and historically very successful in life. A man or woman who has functioned at a high level of professional responsibility, with recognition and success, will recoil in disbelief when symptoms of exhaustion appear. The unwarranted assumption is "once healthy, always healthy".
The simple mention of psychiatry often evokes images of an outdated, upholstered couch in the company of a bearded wizard. This is followed by flashbacks of imprisonment a la One Flew Over The Cuckoo's Nest, over-medication with sedating drugs that results in an ambulatory, "embalmed" person, or use of medications with draconian behavioral, or at a minimum, unpleasant, adverse effects and possible medication interactions.
In addition, the focus of medical ethics has shifted from a paternalistic guiding principle in the day when the clinician worried for the patient in a parental way. This has given way to respect for self-determination, but has placed a great burden on the patient, as well as affording him liberty and respect. The onus is now on the patient to weigh all relevant clinical information before making a treatment decision. He must calculate his own preferred risk-benefit ratio. This may be hampered by absence of information such as prevalence rates of possible side effects, ability to imagine the experience of some adverse effects, and so on.
The fact that anyone seeks or accepts treatment in this environment is testimony to the degree of suffering caused by symptoms associated with significant neurophysiological changes. Neurophysiology simply means the processes of nervous system cellular functioning. The workings of the cell can be affected by many factors such as genetic, metabolic, infectious, toxic environmental, and autoimmune factors.
Consequently, this book is a distilled conversation between a prospective patient and her psychiatrist, which may facilitate making an appointment, provide helpful information, and possibly lead to understanding the clinical challenge for the psychiatrist. It is not intended to be a psychiatric text or represent psychiatric knowledge in any comprehensive, or organized fashion. My patients have been my best teachers. I rarely forget information shared in a personal dialogue with someone who expresses human emotion, often while suffering, and extended with trust. A patient wants to be certain that their feelings and personal information will be received with the intention to understand them and respond for the benefit of its bearer. Moreover, attending people who have struggled with life's toll-takers, such as the neurophysiological changes of cellular exhaustion, or situational burdens has provided me an awe-inspiring example of surviving or coping with suffering. Witnessing patients triumph over existential "testing" has afforded me some measure of courage in meeting my own life challenges. Perhaps it is surprising at first glance that those who initially struggled against establishing a working partnership with me, initially resisting treatment, but later who invested themselves in treatment after re-evaluating their circumstances in light of new information, were the people with whom the most meaningful relationships were forged. In retrospect, this is not surprising. Those who are battle buddies, engaged in a challenging mission with a unity of purpose develop a uniquely enduring, lifetime relationship. My indebtedness to these courageous patient-souls with whom I have worked is only exceeded by my unlimited respect for their strength of character. A person merits respect, who is sufficiently perceptive to recognize appearance of symptoms, brave enough to face the uncertainty of the unknown, and motivated to take responsibility for solving the problem that may not only be interfering with their own optimal functioning, but also causing anxiety or burden for those around them. If only there were predominance of such qualities in my interactions outside the office...
No one plans to be uncomfortable, ill, or emotionally and physiologically exhausted— it arrives unannounced, stealthily, much like an ambush that interrupts one's focus elsewhere. Adding to this confusion is the fact that psychiatric symptoms may appear in someone who has been a high achiever and historically very successful in life. A man or woman who has functioned at a high level of professional responsibility, with recognition and success, will recoil in disbelief when symptoms of exhaustion appear. The unwarranted assumption is "once healthy, always healthy".
The simple mention of psychiatry often evokes images of an outdated, upholstered couch in the company of a bearded wizard. This is followed by flashbacks of imprisonment a la One Flew Over The Cuckoo's Nest, over-medication with sedating drugs that results in an ambulatory, "embalmed" person, or use of medications with draconian behavioral, or at a minimum, unpleasant, adverse effects and possible medication interactions.
In addition, the focus of medical ethics has shifted from a paternalistic guiding principle in the day when the clinician worried for the patient in a parental way. This has given way to respect for self-determination, but has placed a great burden on the patient, as well as affording him liberty and respect. The onus is now on the patient to weigh all relevant clinical information before making a treatment decision. He must calculate his own preferred risk-benefit ratio. This may be hampered by absence of information such as prevalence rates of possible side effects, ability to imagine the experience of some adverse effects, and so on.
The fact that anyone seeks or accepts treatment in this environment is testimony to the degree of suffering caused by symptoms associated with significant neurophysiological changes. Neurophysiology simply means the processes of nervous system cellular functioning. The workings of the cell can be affected by many factors such as genetic, metabolic, infectious, toxic environmental, and autoimmune factors.
Consequently, this book is a distilled conversation between a prospective patient and her psychiatrist, which may facilitate making an appointment, provide helpful information, and possibly lead to understanding the clinical challenge for the psychiatrist. It is not intended to be a psychiatric text or represent psychiatric knowledge in any comprehensive, or organized fashion. My patients have been my best teachers. I rarely forget information shared in a personal dialogue with someone who expresses human emotion, often while suffering, and extended with trust. A patient wants to be certain that their feelings and personal information will be received with the intention to understand them and respond for the benefit of its bearer. Moreover, attending people who have struggled with life's toll-takers, such as the neurophysiological changes of cellular exhaustion, or situational burdens has provided me an awe-inspiring example of surviving or coping with suffering. Witnessing patients triumph over existential "testing" has afforded me some measure of courage in meeting my own life challenges. Perhaps it is surprising at first glance that those who initially struggled against establishing a working partnership with me, initially resisting treatment, but later who invested themselves in treatment after re-evaluating their circumstances in light of new information, were the people with whom the most meaningful relationships were forged. In retrospect, this is not surprising. Those who are battle buddies, engaged in a challenging mission with a unity of purpose develop a uniquely enduring, lifetime relationship. My indebtedness to these courageous patient-souls with whom I have worked is only exceeded by my unlimited respect for their strength of character. A person merits respect, who is sufficiently perceptive to recognize appearance of symptoms, brave enough to face the uncertainty of the unknown, and motivated to take responsibility for solving the problem that may not only be interfering with their own optimal functioning, but also causing anxiety or burden for those around them. If only there were predominance of such qualities in my interactions outside the office...
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