Unfogged Discussion Thread - More Tales From The Emergency Room

Discussion thread for LizardBreath's "More Tales From The Emergency Room" post at Unfogged.

Comments

[bitchphd]

That reminds me of the time when, taking Accutane, I had to deal with a really patronizing doctor whose first question to me was, "and what is the most important thing about taking Accutane?" said in that rising inflection that people use when talking to children. I said, "Yes, I know, I'm taking birth control," and he said, "No, not birth control: we mustn't get pregnant!" which annoyed me, as you can imagine, no end. So when the resident or intern or whoever it was came in later, I complained, and the resident said, "well, not everyone is as educated or responsible as you are." As if that's relevant.

It's that whole blaming-the-addressee for the rudeness or condescension of the speaker thing. I can see the relevance of the alcohol question, and presume the follow up is something about whether anyone has a drinking problem or whatever, but the idea that some classes of people are inherently beyond suspicion--and isn't Hedda Nussbaum going around promoting her new book as we speak?--is not only offensive, but actually dangerous.

[The Idealist]

You are right, both about the silliness of the question--if they want to know if alcohol was involved in the Newt being hurt, this is not the best way of going about it--and about the offensiveness of the notion that the question was OK for a "different population" but not for you.

It was perfectly reasonable for you not to say anything at the time, but you might consider an email to the hospital now that Newt is home and all patched up.

[LizardBreath]

I can see the relevance of the alcohol question, and presume the follow up is something about whether anyone has a drinking problem or whatever, but the idea that some classes of people are inherently beyond suspicion--and isn't Hedda Nussbaum going around promoting her new book as we speak?--is not only offensive, but actually dangerous.

Yeah, and as it happens, they got an affirmative answer to the alcohol question, but did not follow up. Possibly my quizzical look, which I have been told could etch glass, put the doc off asking the next question, but it really shouldn't have, whether it was my race and class or my attitude that did it.

[The Idealist]

look, which I have been told could etch glass

Having seen the look, I can vouch for the truth of this--indeed, I believe that it can etch stainless steel.

[LizardBreath]

but you might consider an email to the hospital now that Newt is home and all patched up.

That's not a bad thought. I wonder if I can do it without fingering the particular doctor who treated the snuggly little amphibian in question.

[LizardBreath]

I said, "Yes, I know, I'm taking birth control," and he said, "No, not birth control: we mustn't get pregnant!" which annoyed me, as you can imagine, no end. So when the resident or intern or whoever it was came in later, I complained, and the resident said, "well, not everyone is as educated or responsible as you are." As if that's relevant.

And this, I don't even understand -- it's condescending, but weirdly so. Did the doc think you didn't understand the connection between birth control and pregnancy, or what?

[Cala]

It doesn't sound like a policy that is designed to work, but designed to keep the hospital from being sued.

Seriously, what child abuser is going to confess suddenly upon seeing a question about alcohol or drug use?

It strikes me that this policy is so they can say 'Oh, we have a policy', which leaves the doctor in the position of a) thinking it's a stupid policy to make a mother whose kid is obviously chattering about playground mischief and b) ready to put his foot in it because he can't offer any good justification for the policy.

[The Idealist]

It doesn't sound like a policy that is designed to work, but designed to keep the hospital from being sued.

Likely true.

[SomeCallMeTim]

I'm on the hospital's side, here. As with Cala, I suspect it's an attempt to avoid suit. Moreover, I suspect it's policy precisely because the hospital worries that letting doctors ask the questions to those they feel need to be asked will yield data that indicates a skew along racial or economic lines.

I'd bet the doctors are OK at sorting out who they need to worry about and who they don't need to worry about. It might, on the face of it, appear to be decided on race. But that might be just a proxy for something like homeownership or relative wealth.

And then doctors deviate mildly from the policy because they're human and hate pointless beauracracy as much as the rest of us.

[LizardBreath]

Sure, the question is no worse than stupid and pointless. The apology, though, was somewhere in the indeterminate realm of racist or classist, depending on what she meant by 'different population'. A society where I get to be treated respectfully by an ER doc because I've got a nice suit and a pale complexion: "Of course it isn't a problem if you have some wine with dinner; heaven knows we all need to unwind after a hard day's work," but someone else doesn't: "These people, though, you get a few drinks in them..." is an unpleasant and inequitable society. It's the kind of thing that can really piss people off.

(and the doctor didn't say anything worse than 'different population, and probably isn't a bad person -- I'm more annoyed about the undeserved deference I got, than the presumed lack of deference that another parent from another race or class might have.)

[tom]

To play devil's advocate: hey may go through this question protocol with everyone in the emergency room, and also apologize to all of them (albeit perhaps in different manners). Their goal is just to discover whether the child is suffering abuse, and remaining nonconfrontational is probably an important part of doing that. Don't put anything past the people who design these protocols. When you're testing for megalomania (or something similar, I forget exactly what), for example, one of the assays is presented as an IQ test, which the subject is then told they aced.

But I donno, and I wasn't there. Certainly casual prejudice is a simpler explanation. As I said, just playing devil's advocate...

[SomeCallMeTim]

But you don't know what "different population" was being referenced, so I'm not sure it's fair to infer that it's race or (and I suspect it's this) class. Moreover, to the extent that race or class is useful in differentiating those in particular need of attention from those that don't, I'd want doctors to know about it. And to the extent that the hospital is stretched for resources, I wouldn't want it to have to expend either time or money running everyone who doesn't fit the profile through the whole rigamarole. I guess I think it's like a doctor not feeling the need to test you for sickle cell anemia because you're white. That seems OK to me.

[Cala]

Moreover, I suspect it's policy precisely because the hospital worries that letting doctors ask the questions to those they feel need to be asked will yield data that indicates a skew along racial or economic lines.

Plus, it gives the doctors an easy fallback, "No ma'am, I have to ask everyone these questions."

Let me make it clear that I think the doctor was out of line in his phrasing, but I am giving him a bit of a pass since all the doctors I know who work at hospitals are always exhausted.

I can also imagine my mom, pretty much the picture of suburban innocence, answering those questions and the growing look of horror and shock on her face. "Do they think I'm abusing my little girl? She just fell down and bit the coffee table! Are they going to take her away? Why do they think I hit her?", which I'm sure would prompt any doctor to reassure her that they don't think *she's* a bad mom.

[I don't pay]

Sounds like nobody's consciousness needs raising, but the writer whom I found most righteously angry about contemporary society's classism about child-rearing was Christopher Lasch, in both Haven in a Heartless World and The True and Only Heaven. Also Benjamin DeMott's Imperial Middle and just about anything by Richard Sennet.

[LizardBreath]

But you don't know what "different population" was being referenced, so I'm not sure it's fair to infer that it's race or (and I suspect it's this) class. Moreover, to the extent that race or class is useful in differentiating those in particular need of attention from those that don't, I'd want doctors to know about it. And to the extent that the hospital is stretched for resources, I wouldn't want it to have to expend either time or money running everyone who doesn't fit the profile through the whole rigamarole. I guess I think it's like a doctor not feeling the need to test you for sickle cell anemia because you're white. That seems OK to me.

Yeah, see, this is exactly the problem. (I'm sorry, SCMT, I'm going to jump all over you now. No hard feelings?)

Rich white people abuse alcohol. Rich white people abuse their children. Being a well-spoken and well-dressed (well, for all relevant purposes. Well-dressed, not really) white woman is no guarantee, and no evidence, that I'm not, or someone else in my household isn't abusing my children. The assumption that I don't 'fit the profile' of an alcoholic or a child abuser (and in context, I can't imagine a meaning of 'different population that wasn't at least classist) because I'm high-income and white is a profoundly racist and classist assumption.

I'm all in favor of reasonable screening for child abuse -- the questioning about how Newt got hurt was not a problem at all, and even though I can see how it might stress someone else out, that'n not a reason not to do it; just a reason to do it sensitively. I didn't react to the alcohol question because I was offended, I reacted because it was silly, and had the potential to be irrationally insulting. If I had 'fit the profile' -- poorer? less well educated? -- would I have had to spend the next couple of minutes defending my drinking habits? If whatever questions would have been directed at someone who did 'fit the profile' were reasonable and well calculated to produce information about possible child abuse, they should have been directed at me. If they aren't, they shouldn't be directed at anyone.

I guess I think it's like a doctor not feeling the need to test you for sickle cell anemia because you're white.

When I say, tell that to someone of southern Italian descent, I don't mean it to be a cheap shot -- it's the same mental error.

[cw]

My sister ran afoul of the emergency room social workers in nyc when her toddler fell down twice on the playground and hit his head. She was really concerned that this might indicate some underlying problem, so she called it to their attention to the fact that it had happened a month before so they would check hard for any underlying condition. (turns out he's just a really tippy kid)

Of course, she ended up investigated with a home visit from social services.

[bitchphd]

possibly my quizzical look, which I have been told could etch glass
Once again, LB, we are twins.

this, I don't even understand -- it's condescending, but weirdly so. Did the doc think you didn't understand the connection between birth control and pregnancy, or what?
I think his lame point was that it wasn't using b.c. that was the issue, but pregnancy. Which is part of what pissed me off--obviously one can't be 100% certain one isn't going to get pregnant; one can only use b.c. and hope it doesn't fail. Plus, that fucking "we." God I hate that.

[bitchphd]

But you don't know what "different population" was being referenced, so I'm not sure it's fair to infer that it's race or (and I suspect it's this) class. Moreover, to the extent that race or class is useful in differentiating those in particular need of attention from those that don't, I'd want doctors to know about it.

Given that the phrase was "different population here" (if memory serves, Unfogged being down again), and that the hospital's in Harlem, we can guess. It's certainly fair to infer that it's race/class that's being referenced, even if the inference turns out to be incorrect. And sure, we want docs to take into account populations that are at high risk; but that doesn't mean we (or they) should use racist/classist shorthand to talk about it. Perhaps especially when we're talking to other people who seem to be "like us." One of my (dark-skinned) girlfriends says, when I report these kinds of interactions to her, "it's amazing what white people will say to other white people," and it's true. I think we *should* object to it, rather than trying to excuse or rationalize it.

[SomeCallMeTim]

LB:

We're disagreeing, but it's not clear where we're disagreeing.

1. I assume the hospital worried less about child abuse and more about child neglect. I could see a reasonable assumption that the more affluent one is, the less likely one is to have a child suffering from neglect - there might be a nanny, etc. Similarly with indications that you are able to hold a job, are well educated, etc. I don't think they care very much about whether or not you drink too much except to the extent that it is likely to effect Newt's health. Maybe not even then - they may only care as to whether it explains Newt's need for stitches.

2. I assume whatever system the hospital has set up, it catches either more people than intended or less. Men are 100 times less likely to have breast cancer than women, hospitals don't think to check men for breast cancer, and such cancer often gets caught at a later stage. To the extent that resources are stretched, I'm fine with that.

3. Doctor friends claim that no computer will ever replace a doctor because doctors don't rely solely on the information given to them by the patients. There are rules of thumb - triple whatever amount of alcohol a patient claims to consume - but they also make decisions based on the way in which the patient answers, how dishevled or disoriented they appear, etc. In this case, you might have appeared to be the reasonable, concerned parent you are, without any reference to race or class. It might be that much of their population doesn't fit that profile.

4. I don't know anything about the associations between child neglect and income, or alcohol abuse and child neglect, etc. I assume the hospital does. Moreover, I assume that the staff at the hospital is in a much better position than I am to sort out what sorts of concerns need to be addressed and what information is a good proxy for the relevance of those concerns. In the absense of evidence that there is either bad faith or a serious misunderstanding about the factors driving the issues they are concerned about, I'm inclined to defer to their judgment. I think this may be where we disagree most.

[Becks]

The post text, for reference, since Unfogged is down:

While I’m still very happy with the care Newt got on Friday (and thank you, to everyone who emailed with sympathy and concern), there was an incident that I wasn’t all that happy about.

As usual, when one goes into an emergency room with a hurt child, I got some social-worker-type questions intended to elicit the possibility of child abuse. This is good: I’m all for it. While it’s a little weird being quizzed about whether you’ve hurt your kid, Newt was very helpful in defusing the embarrassment, in his incorrigibly motormouthed way, by rattling on at great length about which of his pre-K classmates had pushed him into the slide, and with what provocation. The next question was: “Does anybody in the house smoke?” Now, this seems to me entirely irrelevant to the treatment of a kid who needs stitches – but I figured, all right, they want to slip in a public health message while they’ve got a captive audience, and answered that no, no one smokes.

The next question was the really weird one: “Is there alcohol in the house?” What is that supposed to tell them? My impression is that more adults than not drink alcohol; how is the presence of alcohol in a household diagnostic of anything at all that would be of interest to an emergency room physician? (I can see wanting to know if the kid’s injury was due to a parent’s alcoholism – I just can’t see how the question gets you any nearer to knowing that.) So I said “Yes,” but must have given the doctor a quizzical look. She instantly got all embarrassed and apologized, saying that they have to ask because “We have a different population down here.” (Here, as in the location of the emergency room, is Harlem.)

What on earth is that? First, it’s a stupid question to begin with. Second, if it were a reasonable question, what could possibly be the justification for apologizing to me about it because I’m a nice middleclass white lady in a suit with a little blond kid – it’s not going to tell you anything different about an African-American parent wearing a T-shirt, and I don’t have any rights to be free of intrusive questions about my parenting that another parent from a ‘different population’ doesn’t. If I were a parent from a ‘different population’ who had overheard the doctor’s apology to me, I would have been livid. I wanted to bring this up, but chickened out because pissing off a doctor who was about to put sharp things in my son’s face seemed ill-advised. So I’m taking the incredibly effective route of blogging about it instead.

[LizardBreath]

In the absense of evidence that there is either bad faith or a serious misunderstanding about the factors driving the issues they are concerned about, I'm inclined to defer to their judgment. I think this may be where we disagree most.

That's pretty much it. Where relying on judgment based on intangibles results in courteous, respectful treatment to an upper-middle-class white woman, combined with a statement that people from a 'different population' would merit different treatment, I strongly suspect the judgment of being systematically biased.

[The Idealist]

I assume that the staff at the hospital is in a much better position than I am to sort out what sorts of concerns need to be addressed and what information is a good proxy for the relevance of those concerns. In the absense of evidence that there is either bad faith or a serious misunderstanding about the factors driving the issues they are concerned about, I'm inclined to defer to their judgment.

See, SCMT, I think this is a problem. I am not in any way suggesting that you support such things, but racial profiling by law enforcement works on the same basis you are saying is OK for the hospital to use here--law enforcement using a statistical relationship between certain "populations" and certain conduct. Such relationships may exist, but that still does not make it OK to assume that people are a "certain way" because of the color of their skin or the clothes they are wearing.

Not only is this wrong as an ethical matter (IMHO), it is also likely is wrong as an empirical matter. If we take as true that there are statistically significant differences between different "populations" (whatever that means), that may not say anything useful when dealing with individual members of those populations. For example, (making up numbers here) if the odds of a white woman abusing her child are .1 percent and the odds of a black woman abusing her child are .13 percent, that is a huge difference. However, it says little about whether a particular woman being questioned by the doctor has abused her child. For that reason, the black woman and the white woman should be asked the same questions, regardless of the "populations" to which they belong.

[I don't pay]

I suppose only one person in (ten? a hundred?) will be offended at being included in the circle of the good, the trustworthy, the upper-middle-class against the nebulous different population. Many would actually be flattered, put at ease, relaxed, bucked-up. One could imagine including you in against others as a deliberately chosen calming, therapeutic technique.

[LizardBreath]

Idealist, as often, is right. Even if you've got a significant difference between populations, that's likely nowhere near enough to justify treating individuals within those populations differently. (And of course, racial/class profiling is self-confirming. If you grill the poor or minority parents, and defer to the UMC or white parents, you're going to find more child abuse in the first category than in the second. That doesn't tell you whether you would have found more child abuse in the second category if you had looked.)

[I don't pay]

It occurs to me that the comment about avoiding litigation must be right. If they wanted to know I'd like to think that they'd do the questioning better, and more intelligently.

[SomeCallMeTim]

Idealist/LB:

In general, I'm against racial profiling because (a) the yield numbers are so low, (b) the harm (in perceptions of the community) are so high, and (c) because there is little reason for any dominant group to rethink the policy if it is wrong. I'm not sure what the (i) the yield numbers are here for the hospital, (ii) what precise factors the staff based its responses to LB on, or (iii) precisely what the harm here would be and how it might be mitigated (e.g., does the staff give the same answer to anyone, of any class, who looks askance at the questions). All open questions, as far as I can see.

I am pretty committed to the idea that one of the mistakes of old(ish) school liberalism was an apparent pretense that all communities were the same, and ought to be treated on the basis of a single "pure" plan. I don't think it's the appropriate way to design an efficient policy, and I think it ends up hurting both liberal programs and their intended beneficiaries by producing flawed plans.

I leave you, unfairly, with this as my final response.

[apostropher]

I leave you, unfairly, with this as my final response.

Jesus H. Christ.

Kinda reminds me of this.

I can't believe this. Ann Bartow comes by and says, 'That's not funny.'
It's like you're sitting in a bar, and a priest, a rabbi, and a minister walk in.

[SomeCallMeTim]

I don't get it, Apo.

[Shamhat]

I'm a nurse, and live near St Luke's and love their pediatric emergency room. It's almost never crowded. I also briefly worked labor and delivery there as a student.

They are certainly required to ask a bunch of questions to everyone. I'm surprised they didn't ask you about car seat use even though you probably don't have a car. I'm required to ask every woman in labor whether she has a living will or health care proxy, which most find alarming. I always tell them, "We're required to ask everyone who comes into the hospital, and many people who come to our other departments are actually sick." (I also warn them that the "regular diet" isn't enough food for a pregnant or nursing mother.)

However, it is true that hospital staff make assumptions based on race. When I was in the St Luke's L & D, we often called in social workers who had the authority to essentially confiscate babies--the mothers were not allowed to take them home.

The worst case I can recall was a Mexican woman who was 17 and unmarried and sent to live with her uncle here during her pregnancy. During her labor, the uncle repeatedly asked the staff to predict how long it was going to take because he needed to get to his job as a dishwasher and was afraid of being fired. A resident who was unaware of the situation thought he was behaving inappropriately for the father of the baby, and too old for her, and referred her.

The social worker understood that since it wasn't his baby he wasn't going to be entitled to paid time off, but discovered that the family had not purchased a crib, bottles, or formula and told them that they could not take the baby home. The mother, who was one of the few who took care of her baby throughout the night rather than sending her to the nursery, was sent home without the baby on a Saturday--right about the time her milk would normally come in as is the American custom.

They came back that night and had a big argument with the desk clerk (with another patient interpreting), the clerk yelling "You need to do what the social worker said and come back Monday." Then someone came up late for work asking, "Do we know those people getting on a bus with that crib and bags of baby gear?" Yes, that's right, they had bought the stuff new, rather than borrowing it (which is legal), and brought it to the hospital on a bus to demonstrate that they had it, in order to bail out the baby, and the desk clerk told them to come back Monday. My breasts ache just thinking about it. And as a while, college educated attachment parent, I never even considered having a crib or bottles in my household.

In contrast, we had a white woman show up in labor with a breech baby one night. She didn't look good. Didn't look clean, didn't look well-nourished. It was her tenth child, but she told us that had custody of only the youngest--then changed that to the mother of her boyfriend as the one with custody.

We had no prenatal records for her because when she found out that she was going to be sectioned for breech presentation, she decided that she wanted a tubal ligation at the same time, but her clinic was affiliated with St. Vincents (Catholic) which doesn't do them Don't get me started. And of course we couldn't do it for her since the paperwork must be filled out, signed, and witnessed in advance because women are assumed to be incompetent to make a decision about sterilization. Don't get me started.

The baby was low birth weight and was sent to the NCCU, and the mother did not visit during the days that the baby was kept after she was sent home. But she picked up the baby and and took her home, without having to prove her worthiness to a social worker. There was no "indication" for a referral.

Of course I have no idea what eventually happened to either baby.

[werefish]

They triple the amount of alcohol you claim to drink? So if I claim (as is true) that I drink rarely or never, they assume I'm chugging three beers at every meal or something?

I suppose that explains why when I go in with detailed list of my symptoms and what I am doing that might possibly cause it the doctor just nods and keeps asking her mechanical questions. She thinks I'm on a bender and wants to avoid being sued when I get behind the wheel drunk as a goat. And all this time I thought it was because I am a pain.

And I tend to think I_don't_pay is right- the doctor was conferring status on LB by assuring her she doesn't fit with 'those people' for whatever value of 'those people'. It's inappropriate but I'll bet it calms most people down. It may indicate troubling attitudes on the doctor's part, or just a cynical ability to manipulate the unfortunate human tendancy to want to be seen as special. I would still send that email, though.

this is winna, by the way.

[LizardBreath]

Shamhat:

What an awful story -- I can't imagine not being able to take my baby home from the hospital, because some idiot thought his uncle was behaving inappropriately. Good heavens.

[Standpipe Bridgeplate]

Holy cow, there is vastly more winnage on the internets than I had known.

[werefish]

Indeed, the winnas are legion.

There are fewer werefishes, but still a lot. It is sad that both my family nickname and my internetian alias are so common.

[teofilo]

There is apparently at least one other teofilo out there, who posts at Free Republic and various Catholic sites (I'm not sure if it's the same person). He spells it Teófilo, though.

[werefish]

Do people always ask if you are that person, or does the accent mark eliminate that confusion?

I should start calling myself wínná.

Shamhat's story is terrible. I imagine that sort of thing happens a lot. I once saw a Latino couple bring their baby into a doctor's office where I was getting a flu shot. They didn't speak English and the baby was quite clearly sick, but the receptionist behaved as if it were a deliberate offense on the couple's fault that they couldn't understand English. I don't speak Spanish, though, and before I could figure out if I should get involved they left. I hope the baby was okay.

[teofilo]

No one has yet noticed that there are two; I doubt there are many people who frequent both Unfogged and Free Republic. But I suppose the accent mark would help to distinguish if there were any confusion.

[Standpipe Bridgeplate]

Indeed, the winnas are legion.

Wait, are you not the winna I was thinking of? I just meant that I didn't know you had a blog.

[Matt Weiner]

It is possible to go said blog and find out that werefish uses the same e-mail address as the winna you were thinking of. I regret to say, however, that winnafish has set a cunning trap for cyberstalkers, because the link yields, well I'll just quote the first comment:

That is... my penis is useless now. I think I'm going to make sausage out of it.

I only wish to be remembered as the one who sacrificed himself for... whatever it was.

[Standpipe Bridgeplate]

It is possible to go said blog and find out that werefish uses the same e-mail address as the winna you were thinking of.

I know, as I had done so.

NP: Beastie Boys – Licenced to Illocution

[apostropher]

There's a false apostropher out there, too.

HERETIC! THERE CAN BE BUT ONE!

[The Singular Kid]

No one has yet noticed that there are two

B-b-but you yourself did! Just now -- don't try to deny it!

[My Alter Ego]

This is My Alter Ego. There are many like it, but this one is mine.

[teofilo]

I didn't notice that there were two; I went out and vigorously searched for another (and found him).

[werefish]

There is nothing wrong with the beauties of Ayn Rand! She is a goddess of desire!

[Standpipe Bridgeplate]

I await the Leonard Peikoff beefcake.

[jezonimo]

my funny story

A man walks into his local pub with a big grin on his face.

"What are you so happy about?" asks the barman.

"Well, I'll tell you," replies the man. "You know, I live by the railroad tracks. Well, on my way home last night, I noticed a young woman tied to the tracks, like in the films.

I, of course, went and cut her free and took her back to my place.

Anyway, to make a long story short, I scored big time! We made love all night, all over the house. We did everything, me on top, sometimes her on top, every position imaginable!"

"Fantastic!" exclaimed the barman. "You lucky bd. Was she pretty?"

"Dunno... never found the head!"

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