Can't We All Just Think Like Health-Care Providers?

Rodenberg responds to reader e-mails


 
 

Howard Rodenberg, MD, MPH, Dip(FM) | | Thursday, December 13, 2007


My two recent columns about homeland security prompted a mixed response. One group of respondents supported my view, for which I'm grateful. A second contingent told me, in no uncertain terms, exactly where I could go. Rest assured the destination was not a white sandy beach in the Bahamas.

The letters that intrigued me the most came from readers who had thought extensively about the issue and reached different conclusions than I did. Believe it or not, I really enjoy this kind of feedback. Letters like that aren't as good for the ego as the cheerleader letters, but they force me to think ... and thinking before reacting is what these columns were all about.

I'd like to highlight a few comments from these readers. Michael Slade of Greenwood Village, Colo., reminds me that there has been more than one terrorist incident in this country, and that the World Trade Center bombing in 1993 undoubtedly heightened public concern to these issues well before September 11. I'd agree that I was probably remiss in not recalling the import of that incident. But I believe that the visual, "real-time" nature of the WTC collapse (we all watched it on television as it happened) probably had a greater impact on the national psyche than a single momentary, unwitnessed blast. It's really a function of technology. ... No doubt if a camera had caught the exact moments before and after the 1993 WTC blast, we would have reacted more aggressively. Mr. Slade also indicates that previous administrations of both political stripes did not properly evaluate the terrorist threat to our nation, and that (in some cases) we actually sponsored those whom we now wish to destroy. While I suppose that hindsight is always 20/20, I can't help but agree with his sentiments. I think we're doing something about it now because 9/11 demanded a response.

Concern over my implications of the word "conservative" prompted Martin Freibergs of Hales Corners, Wis., to inquire whether I believe that conservatives have a mission to discourage independent thought. He also notes that conservative and liberalism are necessary checks upon one another. Finally, he considers that some "conservative" actions, such as seatbelt legislation and child restraint laws, are necessary for the good of society.

Mr. Freibergs and I are actually closer in our views than one might think. I don't like the way the term "liberalism" has been applied in the political context. I prefer the way Father John Neuhaus, a "conservative" Catholic priest, thinks about liberalism. In the sense that to be a liberal means that each person has the opportunity to attain their own level of achievement, everyone should be a liberal. I would add that the freedom to achieve carries with it the mandate to act responsibly and be accountable. To me, this meaning is separate and distinct from certain of the wild-eyed "anything goes" and "everyone's a victim" attitudes of some political and social liberals. I do truly believe that extremists on both ends of the spectrum, both liberal and conservative, are more interested in applying labels and making enemies than in establishing genuine dialogue and reaching compromise.

Political liberals and conservatives are necessary checks upon on another, and should be so. My problem with either label is when they become reflexive and mutually exclusive, or when one group demonizes the other. Sometimes the more "conservative" act is clearly necessary. Passing and enforcing seatbelt laws is an absolutely correct action, even if it impinges upon the freedom of drivers to do as they please. The test of whether a plan or policy is too conservative is if it interferes with the ability of individuals to reach their ultimate potential. Requiring someone to buckle his or her seatbelt clearly passes this test. Thinking like a health-care provider and considering public policy in terms of relevant facts and problem management lead to the best decisions. Acting on reflex, emotion or ideology does not.

The JEMS Web site has already published an eloquent letter of response from Gary Eddings of Silverdale, Wash. Mr. Eddings begins by pointing out that thinking like a health-care provider may not be foolproof, as the practice of medicine is far from perfect. Thinking less like a clinician and more like a researcher may yield a better perspective. He then establishes an analogy between world terrorism and cancer, noting (correctly) that in order to remove the cancer, some "healthy cells" must also be lost.

I would agree that medicine is absolutely more of an art than a science. When I was teaching at the University of Florida, I used to have a woven bracelet that I bought in a "spiritual" shop in New Orleans. I'd put it on before giving a lecture to remind myself that medical legends are often not fact and that much of medicine is not too far from voodoo.

I think the cancer analogy makes sense. I had toyed with it in an effort to determine my own view of the war in Iraq. However, the same propositions may lead to different conclusions. There are some cancers, such as prostate cancer, that we monitor closely without aggressive care a little symptomatic or palliative care as needed, perhaps, but not full-blast radiation and chemotherapy that kills the patient along with the tumor. Either way, we really are both thinking like health-care providers, trying to put some logic behind our thoughts, which is a lot more than most of our politicians and pundits do.

Mr. Eddings' letter reminds me that sometimes I need to explain my train of thought a bit more clearly. I need to note that when I said I would "send my son to Canada," it was not a bit of counterculture 1960's social activism entering my head. A man I respect, a military veteran who is (in many ways) more liberal than I, said that one thing he would never hold against President Bush or former Vice President Quayle was that they served in the National Guard rather than in Vietnam. If their fathers had something to do with their exemptions, then so be it. His point was that if you love your child and you have the power to do something to remove your child from harm's way, you do it. A volunteer army poses a different set of issues than the draft-based military of the Vietnam era. If our children make an adult decision to enlist, then the choice (and risk) is theirs alone, and we pray that God watches over them in the job they do. But when a child is to be "taken away" through conscription, would I do what ever I could to get him out of it, or at least off the front lines, if he allowed me to? You bet I would, and I think most of us would do the same.

While these correspondents may disagree with me on issues of public policy, their comments reinforce my belief that people of good faith can honestly agree to disagree without resorting to stereotyping and accusation. On a more basic level, dialogue such as this reminds us how fortunate we are to live in a land where we can disagree. The freedom of expression is one of the few values that hold together an increasingly fragmented nation. The constructive use of this right is a challenge to all of us.

Author's note

I wrote most of this column on Wednesday, March 19. It was a frustrating day, highlighted by two airline flights delayed by storms and watching lighting, up close and personal, at 33,000 feet. At 10 p.m., Atlanta Hartsfield was its usual chaotic self. At 10:15, an eerie silence filled the concourse as the entire airport stopped to hear the president say that the war was on.

Americans have been divided about the need for this war. I've personally wrestled with my own views on the subject. In the end, I think I agree with the columnist Joe Klein, who mentioned in an interview that this was the right war, but at happening at the wrong time and begun in the wrong way. In my mind, there's no question that Saddam Hussein has to go. I don't think he poses a major threat to us, but he's clearly violated international rule, and he is the incarnation of evil to his own people. There may have been better moments in history to begin this process, and better diplomatic strategies may have led to more international support for a preemptive strike. But he undoubtedly needs to go.

Now that war is upon us, it's time to support our troops. We might endlessly debate the need for war. It is our right in fact, it is our duty as citizens to make our voices heard, whether in support or opposition to government policy. We can continue to advocate for change if we wish, but we cannot fail to back those who, through a sense of duty, pride, and commitment, willingly put themselves in harm's way. So if you'll allow me a religious indulgence, God bless our soldiers, sailors, and airmen. Let them be successful in their mission. Most important of all, let them come home soon.


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Related Topics: WMD and Terrorism

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