Oct 9 2008

Divorce, Cambodian Style

A couple in Cambodia has given new, and quite literal meaning to the concept of dividing up marital property, according to today’s on-line  BBC NEWS.  After 40 years of marriage, an argument prompted the couple to take their splitting up into their own hands, in order to avoid the high costs and lengthy waits involved in court sanctioned divorces.  They split their home in half–literally.  Half of the house remains on the original site, about 56 miles from Phnom Penh.  The former husband has moved his half of the house off of the lot, to an undisclosed location.  According to a local attorney, the splitting of the property does not constitue a legal divorce.

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Sep 22 2008

Text Messaging: Bane or Boon

     Text messaging is a lot like like rock and roll music.  Young folks love it, and their parents find it irritating.  It is, at this stage, primarily an aspect of youth culture, and with its odd abbreviations, used apparently to avoid exhausting the thumb muscles, it can seem impenetrable.   For example, “I see you” condenses to “i c u” for seasoned text messagers.

     It is also a medium that resonates with youth culture, largely because it is so cutting edge and modern.  This connection was clear to Barack Obama’s campaign staff, as evidenced by the announcement of Joe Biden as Obama’s running mate via large-scale text messaging.  Text messaging is instantaneous, and anyone with a cell phone and a weekly allowance can use it.

     Yes, some have complained that students text message in class,and thereby miss things they should be learning.  In terms of social interaction, it has been suggested that texting, like instant messaging (or IM’ing) and email, retards social development, since such distant, electronic communication cuts off any possibility  of learning to read and appreciate social cues, such as body language, facial expression and tone of voice.  But, as we have come to see in recent weeks, that is the least of our worries when it comes to the downside of text messaging.

     People sending and reading text messages from their cell phones are being killed or seriously injured with frightening frequency.  Of course, it is not the text messaging by itself that is dangerous, but the circumstances under which people choose to avail themselves of this technology.  We have all seen them, and many of us have been them:  the people text messaging, heads down, eyes focused on their cell phones, while navigating busy city crosswalks; the people driving cars on congested streets and highways, one hand on the steering wheel, one hand on the keyboard of their cell phones, and their eyes frequently leaving the road to focus on the screen of their cell phone.  Is it any wonder that pedestrian text messagers are being hit by cars?  Should we be surprised when distracted drivers plow into other cars or pedestrians?  In my own experience, I have witnessed countless pedestrian vs. pedestrian accidents on New York City sidewalks, when a text messager (or text receiver) is walking, head down, apparently oblivious to other pedestrians and where such pedestrians might need to walk to.  Luckily, these little brush ups tend not to result in anything serious.  But, give it time.  Sooner or later, one of these self-absorbed souls will knock over a frail, elderly person, or upset a baby carriage, causing grave injury to the more vulnerable users of city sidewalks.

     Although it is still under investigation, there is at least some evidence suggesting that the driver of one of the trains involved in a recent collision that resulted in multiple fatalities in Los Angeles was texting when his train crashed, killing him.  In a front-page article in Saturday’s New York Times (Sept. 20, 2008), the authors quoted a Silicon Valley “trend forecaster” who declared “the act of texting automatically removes 10 I.Q. points.”

     The bottom line is that text messaging is causing preventable injuries.  In my home county of Westchester (New York), it is now illegal to text while driving.  That is a start in the right direction, and neighboring counties should take notice and emulate Westchester’s action.  But what about pedestrians?  Most of us wouldn’t walk down a busy city sidewalk or street reading a captivating novel.  You could end up falling through an open manhole, or under the wheels of a city bus.  You could also send an elderly woman balanced on a cane onto the concrete sidewalk, causing her to fracture her hip, her arm or her skull.  But text messaging, with its ease of use and instantaneous results, is as captivating as any book, and probably more so.  And yet, users walk down the sidewalk, in its thrall, oblivious to the danger to themselves and other pedestrians.  The law must catch up to the reality here, and texting while walking among others, that is, in city settings, malls and the like, should be outlawed.  If you want to text while you’re climbing a mountain out in the wilderness, go ahead!  You might step off a cliff and plunge to your death, but you won’t hurt innocent people in the process.

     And from my professional perspective, I wonder what will happen when the lawsuits start.  If Mrs. Jones, driving her car, runs down Mr. Smith, who was crossing the street, because Mrs. Jones was texting while driving, who is responsible for Mr. Smith’s injuries?  Is it Mrs. Jones, because she chose to text while driving, knowing that she might become distracted?  Is it the cell phone service provider who enabled Mrs. Jones to engage in such reckless conduct?  Is it Mr. Jones, Mrs. Jones’ husband, who chose to  text her the news that their house had been foreclosed on due to the mortgage crisis?

    All such suits are avoidable, if our government representatives act now to address this problem.  And in the meantime, save the texting for the classroom or the boardroom.  You may lose something in the process, but at least it won’t be your life.

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Aug 1 2008

If Patient Information Is Good For Your Health, Why Is It Being Withheld?

There can be no question that the sharing of information positively influences the quality of medical care, whether that care is being provided by a top hospital in New York or Boston, or by a country doctor in a remote area of Appalachia. The sharing might occur through an article in a medical journal, such as the New England Journal of Medicine. Or, it could take place through the wonders of closed circuit videocasts, during which a physician on one side of the country can observe a physician on the other side perform a surgery about which that first physician needs to know. The bottom line is that physicians have plenty of knowledge that could benefit their younger and less experienced colleagues, which, when shared, ends up benefitting you, the medical consumer, because of the better medical care it generates.

Why, then, does American medicine not do all it can to exploit this principle for the greater good? We are in a political climate in which state medical associations, and medical liability insurers react to medical malpractice lawsuits by blaming the lawyers who bring them, instead of looking to how the healthcare system could be improved so that the mistakes that underlie such suits happen less frequently, or even not at all.

A case in point is our failure to implement a national registry—a nationwide data bank of results for particular surgeries using particular medical devices—so that problems can be detected early, and fixed quickly. The “fix” might be a modification to the medical device, i.e., an artificial hip socket, or additional training to the surgeons installing them. The New York Times addressed this subject on its front page earlier this week (7-29-08) in the context of artificial joints (“A Call for a Warning System on Artificial Joints”). Because we do not have such a registry, patients undergoing joint replacement surgery here run up to twice the risk as patients in countries with a registry that they will need to undergo a replacement procedure in the future, according to the Times article. This failure to implement such a basic system results in more, and unnecessary surgeries, along with more surgical risks, including infection; more costs to patients and insurers; and more time lost from work. And, not having the benefits of the wealth of information such a registry would provide means that many surgeons end up providing less- than- optimal care, when they could easily have the best and most recent knowledge at their fingertips.

To the same deleterious effect is the HIPAA law (The Health Insurance Portability and Accountability Act of 1996). Ostensibly created to protect the privacy rights of patients, it has resulted in a system in which obtaining a patient’s medical records in a timely manner requires needless paperwork, and sometimes dangerously large amounts of time. Wouldn’t it make more sense to create and maintain a national databank of medical records of everyone who has ever received medical care, and make it accessible to every hospital and doctor in the United States? When you are brought into your local emergency room, unconscious after a car accident, and your family cannot be contacted, wouldn’t it be wonderful if the hospital’s staff could plug your name into a computer, and learn what medications you are fatally allergic to? Would it really be so bad if the staff learned about that anal fissure repair surgery from 20 years ago? This is another step that would be relatively painless to implement, and would end up saving lives, in addition to medical costs. Why is it not yet in place?

Solutions are out there. It is up to our government and the healthcare industry to make use of them. And the sooner, the better.

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