What Really Goes on in the E.R.

Why it’s important to discuss health issues in the Fray.

A very welcome development this week, after the article in “Medical Examiner” on hospitals’ E.R. problems produced a monster response from readers—more than 400 top-posts. The Fray team’s job is to read as many of these as possible and then try to summarize the reactions as helpfully as possible for other readers. But in this case, one of the authors of the piece—Jesse M. Pines, who co-wrote with Zachary F. Meisel—bravely read a very high number of the posts and wrote in the Fray about them for us. He identified five different sets of responses, including:

1) Complaints from angry health care providers who felt they’d been insulted. Answer—no such criticism intended.

2) Patients giving experiences of the system, good and bad.

3) Congratulatory messages from those who agreed with the article.

4) Posts from nurses who commented on the “bed-hiding” issue. Answer: “The point was not to say that anyone is lazy—you are just as overloaded as we are in the ER.”

The fifth group was from providers who talked about other problems in the health care system that contribute to crowding, and our author had this to say:

While I’m glad that you used this forum to discuss these issues because all are important, the article was about the hospital practice of boarding admitted patients in the ER. And how in some communities with high Medicaid and uninsured populations where hospitals are capacity-constrained (where demand for services exceeds supply on both the ER side and inpatient side), boarding is the profit-maximizing strategy. While Zack and I thought we explained it in the article, I am sorry if this was unclear to some.

He argued his case with more details and references before concluding:

I thank you again for your interest in this important topic that affects all Americans. Because sooner or later, you and your loved ones will all need to go to the ER. This needs to be discussed in public forums by people who understand the issues and can provide suggestions to hospital administrators and policymakers who have the power to eliminate boarding through objective measurement and accountability for this crisis.

Anyone interested in the issue should read the post in full here. And Mr. Pines is most welcome to come and help us in the Fray any time.  MR 5:30 p.m. GMT

Tuesday, July 22,  2008

Prized Fray regular wmccomninel watched Generation Kill, read the review in “Culturebox”, and started a great thread which led to his laying this thought on the line:

My own life was negatively affected by serving in both wars in Iraq, that much is certain. And yes, even if you just drove to the mall, when America went to war so did every American citizen, happily or not.

His top-post thoughts on the program were fascinating, worth quoting at length:

War is not just another slice-of-life experience. It tends to be thoroughly atypical in many dimensions simultaneously which makes its only points of reference internal to the experience of war itself. In other words it gets a little bit crazy when viewed from an external, normal frame of reference. When one goes home again and things are normal there is no way to translate the war experience into non-war terms. There simply are not enough common reference points upon which to draw for you to align the two different experiences in ways which are even vaguely accurate. The parallels to gang wars which the reviewer suggests that the producers have brought with them from their work on The Wire are perhaps as close as one could aspire to in such an effort. They are still woefully inadequate to the task however.Crime within a society has a certain business-as-usual flavor (rare bizarre incidents excepted). That is why there are so many police shows, it is just too easy make another new one. War on the other hand defies all boundaries. It is the complete absence of normal law and order, hence the absurdity of trying to define ‘war crimes’ as if there were a proper way to conduct day-to-day war operations as we do with the goods and services of the civilian economy. Indeed I find the mix-up stems entirely from the way that so many people view war as being just ‘business by other means’ and not the last resort of a sovereign nation at severe risk of its own dissolution.

Geo140 had experience in the Marines and watched the original program with interest:

I don’t know that I look at Generation Kill as a slap in the face to anyone who served in the military, or in the war. I simply see it as a pretty good story with some accurate details and a harsh exterior. If you’re looking to this show to find a reason to hate the Marines or the military, or support an archaic view of what a soldier is, then you were lost before this show even aired. And if you’re watching this show just to get a glimpse of what war could be, and what the men and women who fight those Wars might face, you may be better off–but only slightly.

Some of the arguments the program and article produced were very angry –just the list of thread titles would tell you that: Among the repeatable are “You’re an idiot,” “Same old tired story,” and “Generation Wuss.” The post featured above was called “ACME War Services, the musical”—you’ll have to read it to find out why. MR…4 p.m. GMT

Thursday, July 17,  2008

Fray poster Expectator had a way to solve the whole New Yorker cover controversy:

Put the same drawing on a TV screen with the Fox emblem in the corner and a pair of couch potatoes parked in front of it–put that on your cover, and you’ve got satire.

And howlless was equally clear:

Any satire that can be easily used to further the viewpoint it’s trying to satirize, is, by definition, a failure. The New Yorker cover fails abysmally.

Readers read the articles—in “Press Box” and “XX Factor” and “Politics“—and came to have their say. These are Slate readers: Whatever their politics, 95 percent of them know that they are against racism, stereotypes, and dirty tricks. But where exactly did this cover come on the spectrum? And what else did they know?

Many knew they were uneasy with the cover but found it hard to define the reason. Quietbelow was unusually exact and put it well:

Satire is usually framed around the actual person or institution being satirized…Obviously the point here, assuming there’s nothing sinister going on, is to satirize false information. But it’s an extremely awkward proposition to satirize false information about a given person by actually depicting that person. There’s a cognitive disjoint, because historically the satire should depict the subject of satire, but here it’s Obama, who, again, assuming the best, is actually not the target.

S/he then went on to say,

I think it was a silly decision to publish it because it could be so easily misused and was so awkward in its general execution…Awful, horribly offensive? Of course not. Stupid? Yes. Though I have a feeling that the editorial staff on the magazine would fear the latter designation more than the former.

Some readers had philosophical concerns—this is tubbs, who knows a good reason to leave the whole issue be:

Our minds are truly the last private places on earth; particularly today in our wiretapping, war on terror, war on drugs, MySpace, You Tube, helicopter parents, constant surveillance, always “on” society. Moving to punish others for their innermost fears or castigating others for potentially stoking these innermost fears is an invasion of privacy of the highest order.

And wayhey1 knows:

The New Yorker better get away with this, because if they don’t, then we know democracy is already dead.

Pani has an explanation for the worries about that fist jab: What do Americans know of cricket?

The reason Americans think the fist jab is a terrorist innovation could well be that they don’t play cricket. Indian cricketers have, when batting, been using the fist jab at least for a couple of decades if not more. It works so much better for their gloved fists than the high fives.

Meanwhile, KenR1029 has a serious concern:

Little did I know that all those years trading fist bumps after a great play on the court during noon basketball games at the Y has probably compromised my ability to ever run for public office.

So, that’s what we know: why there’s never been a basketball-playing (or cricketing) president. MR   3 p.m. GMT

Monday, July 07,  2008

A group of females: Girls can choose one to identify with, and it could be Samantha. In the light of the new movie, is it all about the story or all about the outfits? Is it empowering to women or does it teach them the wrong lesson? Does the thinking feminist love them or hate them? We’ve been here before, and not that long ago, but this time it’s not Sex and the City, it’s American Girl (AG) dolls, discussed in a recent “IM” article.

We have mentioned that Slate’s Fray team divides up the work very easily and casually, but American Girl was always going to be mine. This one is personal: I’m an even-handed defender of Barbies in Slate, but still, my daughter learned to read with a Samantha book because it was the only way to make me buy her the doll. On a recent trip to Manhattan, we spent an unplanned morning entirely at American Girl Place. I finally said that I would buy her—she’s now 16—something for old time’s sake. But the only thing she wanted was the (free) catalog—and that’s going to resonate with the Fray posters because it featured in so many reminiscences: poring over the catalog comes up over and over.

Nancyh posted a good analysis of ways to empower your daughters and resist consumerism, and it would take a mean-minded cynic to smile when she revealed that her daughter is all of 5 years old. Oh the years lie ahead, Nancy. Revrick posed a question: “Does such a thing as responsible consumerism exist … ? Consumerism, by its very nature, it seems to me, bulldozes right through such prudent concepts [as saving and budgeting].” He was roundly told off by alittlesense:

Yes, Heaven forfend! Buying a doll, the gateway to vice of all sorts. The only bulldozing I see is the idea that everyone except the posters here at the Fray are weak-minded fools who can’t be trusted with a burnt-out match, much less money, dietary habits, voting habits, fireworks, the internet … the list goes on and on and becomes more dreary with every issue of Slate.

Treefitz was one of many who wanted to share her memories with other readers, in this case of how the whole family got involved: “AG dolls are not just about little girls … they are about mothers and daughters, grandmothers and granddaughters. They are about shaping human culture.” Rather sadly, Fridhem wrote back to say:

You seem to be under a misconception of today’s mother. Most of us aren’t able to have all that time to spend making and creating the trunks, clothes, etc. … in today’s economy, most of us have to work just to make ends meet … barely meet. I’m happy for you that your family sounds as though it was well off enough for you to have that extra time. Rare few do these days. … We are still shaping, just in a different way, dealing with the constraints we are given.

Jmv told us about a craze for customizing dolls:

More compelling is the DIY crowd that seeks to rebrand dolls to their own taste, or create special OOAK (one of a kind) editions, at times with completely home-made clothes. … Just search for OOAK. … and you’ll see a unique universe of personal creations.

Frankly I can’t recommend this—looking at a page of these creations made me jump back in my seat in horror. But in terms of creativity, it’s surprising the AG magazine wasn’t mentioned more: It is a wonderful thing, completely unlike any other magazine for young girls. It has sensible advice, features about high-achieving girls, and terrific ideas for low-cost items to make, and cheap and easy ways to entertain.

Bookmama had her own money-saving idea:

They are dolls. Children have imaginations. Why not buy just one and a set of clothes from different eras? Why can’t a Samantha doll dress up in Depression Era clothes?

—and she also says that the dolls do help children learn about history and women’s rights.

For amhuy, “It was all about the story. Like others who posted here, I was also obsessed with any story containing any independent girl fighting for it: Anne of Green Gables, Heidi, Secret Garden. …” A related point came from RW99:

The lasting appeal of the dolls went beyond the cute outfits and accessories, it was directly related to the stories told in their books, the ways in which these girls faced problems and challenges and overcame them with the help of their family and friends. Besides my everlasting idol, Laura Ingalls, they were the only female role models who stood out for me at that age (I’m talking 8-10 years old) as more than just the typical “helpless girl,” who usually had a brother who got to do all the cool stuff.

We know all about that in my house. My son, aged about 6, once complained that his sister had hit him with her doll. It sounded so funny that we laughed, at which he said, “Yes but Samantha is very solid.” That became a family joke, but hey, maybe there’s something to it.  MR3:30 p.m. GMT

Wednesday, July 02,  2008

Any day now we’re going to make  list of the words and phrases that strike dread into the heart of a Fray editor. A personal favorite would be “causation and correlation—don’t you realize they’re different?” Yes, we do, everyone does, could we start from that and move on? (This week it was the article on movie critics.) And how can we describe the Fray on the Catholic Church? Un-Christian, that’s it. Mean-spirited is another phrase that came to mind. But we liked TheStranger’s theory, here, that the Fray is like the Bardo from the Tibetan Book of the Dead—a place, apparently, where you fight demons, under the impression they are from outside. In fact, they are your own personal demons: “you cannot fight them but negotiate with them until you find the right light to follow to non-birth. Maybe this forum is the Bardo and we are all dead. Let’s negotiate.”

Good luck with that. In the meantime we may as well stay on the dark side and go with a list of some of the prize insults offered in the Fray in the recent past:

“No one has ever questioned my abilities in quite your patronizing manner. Hats off to your level of condescension.”— Aizmap

[To a poster calling for lower speed limits] “Get off the road Granny”— tjcerveza

“I’ve seen Fray arguments using four-letter words that were better reasoned [than this article].”— Pryoslice

[On Tolstoy’s Anna Karenina] “That the reviewers were so eager to accept [Anna’s] narcissism and wrong behavior shows only that … they find her to be like their friends and acquaintances: morbidly self-obsessed.”— Tresor

[Addressing the argument that the childless will need others’ children to look after them] “What makes you think I want your insipid childcare-raised kids diapering me when I am old? I’d sooner euthanize myself than be forcibly tranquilized by the autocratic zealots in aged care that call mass forced tranquilization ‘nursing’.”— billodowd

None of them seemed to be in the Fray to make friends. Any of their comments might have been a candidate for Fray post of the week. But that prize, if it existed, would certainly go to Zuko—to a post with the unlikely name “The Fray grows up.” In a touching and bravura performance, he told us:

The little blond haired girl I loved in the front row married the wrong guy, twice, and now she sells real estate; a few years later, another one, a little brown-haired girl, broke my heart completely in two. We didn’t get flying cars, OJ did it, Britney got fat and went nuts. I don’t live in a thatched hut in Polynesia attended by sloe-eyed, pastel-lipped, beauties of Gaugin, the Red Sox finally won one. I didn’t get what I expected and I have more than deserve. No mysteries left to solve.

But still, cheerfulness broke out, and he had good predictions for the Fray. The post should really be read in full, here. And as TheSranger said, “Let’s negotiate.” –MR … 9.30 p.m. GMT