Wednesday, November 7, 2012

Obama rhymes with Ohana

As my daughter read on Twitter, à la "Lilo and Stitch":
"Obama rhymes with Ohana. Ohana means family, and family means no one gets left behind."

Sunday, November 4, 2012

Define “poor”

A couple months ago, Fox “News” pundits pooh-poohed a survey about poverty in the United States, expressing amazement that, according to the survey, something like 90% of all poor people own a refrigerator. Fox’s rationale? If someone owns a refrigerator, how can they be poor?

A couple days ago, conservatives were at it again: Romney economic adviser Kevin Hassett in a Wall Street Journal article questioned how someone can be poor if they own a microwave oven (Daily Kos).

When I was ten, my family visited Puerto Rico. Several times during our stay we drove a causeway in San Juan over a shantytown on stilts along the banks of a dirty, marshy river. My father explained that people lived there because they couldn’t afford a house on land. Each time we took that highway, I stared at the houses and people below. I knew they were poor, yet they were fat and wore nice clothes. I was puzzled. This didn’t square with my picture of poverty. When you are poor, you're supposed to be starving and dressed in rags.

When my eldest daughter was 14, she went with a small group to Bangladesh through a project sponsored by her school. While they were there, they visited a slum in Dhaka. When she came home and talked about the visit to the slum, she was surprised that even though the people who lived there owned almost nothing, most of them had a cell phone.

I can’t tell if Fox News and Hassett are being deliberately obtuse or just disingenuous. Do conservatives really need to be told that how things look are not necessarily how things are? As a child, I didn’t know that cheap, high carbohydrate rice and beans were an Island staple and that clothing can be cheap or expensive. And things once deemed luxuries are inexpensive today, and to some people, necessities: Dhaka slum dwellers may live in shacks but they all have cell phones. Does this mean they’re not poor?

Poverty is not about the things people have. It’s about things and opportunities they don’t – nutritious food, appropriate clothing, decent housing, safety, education, and the ability to acquire these things for oneself and one’s family.

My message to Fox and Hassett?

Grow up!

© 2012 Kvick Thoughts. All rights reserved.

Tuesday, October 23, 2012

Age of selfishness (or getting my way – what I want, when I want, how I want)

I was making dinner and handed the onion chopper to my teenage daughter who was sitting at the table doing schoolwork. “Would you chop this, please?”

She accepted the chopper. “What are we having?”

“Lasagna,” I said, aware that that she doesn’t like it.

She suddenly stopped chopping. “I can’t support that.”

I laughed. Her reply epitomized the current political and social culture of the United States, if not the world: If you don’t like the outcome, don’t support the process! But as a parent, I was also a little irked: It’s one thing to express an opinion; it’s another not to cooperate because she doesn’t like the menu. As the designated cook for the family that night, I needed her help whether she liked it or not.

In an online article, “Why We Fight for Economic Freedom,” Charles Koch of the infamous Koch brothers tries to equate government intervention in American business with central planning in the former Soviet Union by listing a series of platitudes that warn about the danger of big government and power with no acknowledgment that American and Soviet economics evolved from completely different systems of government, and that, most tellingly, in the United States, “‘the government’” is you, me, and even Charles Koch. The irony, as any first-year economics student can tell you, is that unfettered economic freedom inevitably leads to oligarchy and monopoly, either public or private. “Nations with the greatest degree of economic freedom [read: limited government] tend to have citizens who are much better off in every way,” writes Koch. Not necessarily, Charles, unless you mean we’re all better off if we do what you tell us.

Harold Simmons, one of the biggest contributors to Republican candidates and causes during this election, also believes his business acumen justifies a certain derring-do. Charles Homans writes in The New Republic (May 10, 2012) that in 1993, Simmons used the pension fund of one of his companies to take over another company, a move the U.S. government deemed unduly risky. When he found himself in court, Simmons justified his action by claiming the deal was a prudent investment, but the judge ruled against him anyway. “‘That’s when I started contributing to politicians with free-market and antiregulation [sic] agendas,’ he later told [The Wall Street Journal]. ‘If the Labor Department hadn’t sued, that pension would be as rich as me.’” So in Simmons world, the ends justify the means? And what if he had been allowed to proceed and had been wrong? Bernie Madoff?

Democracy allows everyone an equal say in how they are governed in accordance with principles that permit them to live free from oppression or coercion by others. (Thanks, Wikipedia.) It does not mean getting your own way. Nor does it guarantee efficiency. Democracy is about helping as many people as possible get their own way while protecting us all from individuals and groups who would impose their will on everyone else if they could. When it comes to democracy, Koch and Simmons thrive because of government, not in spite of it. I guess they missed that day in civics class.

As I told my daughter, “If you don’t like what I’m making, don’t eat it.” But it's my job to make dinner for everyone, and as a member of the family, she's expected to help - even if she doesn’t like lasagna.

© 2012 Kvick Thoughts. All rights reserved.

(See related post Corporate give and take.)

Friday, July 6, 2012

Winning an election vote by vote

When you read about the ridiculous amounts of money being channeled by PACs and billionaires into the 2012 election – all sanctioned by the Citizens United Supreme Court decision – it’s easy to feel overwhelmed and discouraged.  How can a candidate without big money ever hope to win an election?

Then I think about Quaide Williams.

Quaide is a U.S. citizen who lives in Germany. Two years ago, Quaide, inspired by Republican Sarah Palin and her campaign bus, started planning a 6-week, trans-Europe voter registration bus tour to register Americans who live in Europe for absentee ballots in the 2012 election.

U.S. citizens who vote from abroad are an overlooked but increasingly important block of voters. In the 2008 U.S. senate race in Minnesota, for example, Al Franken won the seat by 312 votes. This is fewer than the total number of absentee ballots received in Minnesota during that election. And according to an article in The Huffington Post, if the number of U.S. citizens who live aboard were a state, it would be the 18th largest in the U.S.

Although the tour was organized in cooperation with Democrats Abroad, Quaide and his fellow passengers, Americans who live elsewhere in Europe and who join him for a few days at a time, will help register any U.S. citizen who wants to vote regardless of party affiliation. Why?  Probably because they, like me, believe voting is essential for a healthy robust democracy. Of course, they would prefer to register more Democrats than Republicans, but they understand that the act of voting is important in itself.

The bus tour is essentially self-financed, and driver and riders rely on members of Democrats Abroad to house and feed them as they travel from city to city. Last Saturday, following a busy afternoon in Stockholm, Quaide and his “roadies” made a quick stop in Västerås, a city near me. I greeted them with coffee – this is Sweden after all – and a canister of homemade peanut butter cookies while they went into action. We received local media coverage and even registered a couple of voters.  An hour and a half later, at 6:00 PM, Quaide and his team hit the road again for a 5½-hour drive to Oslo. The bus tour will visit 27 cities in 13 countries.

Unless the PACs and deep pocket donors are literally buying votes, it’s still flesh and blood individuals – I can’t say “people” for legal reasons – who will decide this election.  And it’s important to remember that the biggest spender doesn't always win.

How do you counter the influence of big money in an election? Vote by vote, with dedicated volunteers and an occasional homemade cookie.

© 2012 Kvick Thoughts. All rights reserved.

Thursday, May 24, 2012

Letting go - parents and kids

I was cleaning the other day and ran across two journals I had started when my children were young. I had intended to write down memorable things they said and did as they grew up, but I didn’t get very far. Not surprisingly, “life” intervened and I had made only a few entries in each notebook. But one item caught my eye. My eldest daughter had told me, “I want to be poor when I grow up so I can live with you.”

I’m flattered she had loved me so much.  Out of curiosity, I decided to test her to see how she felt about this today. But I posed the question a little differently. “If I’m poor when I retire,” I asked, “how would you feel if I lived with you?” “Well,” she hesitated, “if you absolutely have nowhere else to go, I suppose you’d have to.”

What happened to my loving, trusting little girl? What a difference a few years make!

When kids are young, they can’t imagine life without their parents. When I was young, I thought children died when their parents did. I obviously hadn’t thought this through, but that didn’t matter.  I had no concept of myself independent of them. We were completely symbiotic: if they die, I die. It did occur to me that, by this logic, if they died “tomorrow,” I would never grow up. This puzzled but did not worry me. I thought that’s just how things are.

But my parents did not die, hence my ability to write this post! It’s the paradox of parenting:  you want your children to love you, and to some extent, need you, but it’s your job to teach them to live without you. The truest act of love is to drive your children away! Maybe that’s why my parents gave each of their children a suitcase as a high school graduation gift.

As my daughter intrinsically knew, parents and adult children in Sweden and in the United States do not live together unless they have to. So she needed the excuse of poverty to continue to live with me as an adult. She did not yet know she can have both self-reliance and a live-in mom, if she wants.

But now she does, and she’s no longer as keen on the mom part. Paradoxically, the better I do my job as a parent, the less my children need me. Yet, the more I need them.

I’ll miss her when she moves on. But maybe she’ll miss me, just a little, too.

© 2012 Kvick Thoughts. All rights reserved. 

Thursday, May 10, 2012

I feel vindicated!

It's official: Västmanland county (landstinget Västmanland) has the highest number of patient complaints of all counties in Sweden. Go, Västmanland!

Read more in VLT.

Monday, April 2, 2012

Läkare är inte ofelbara

(To read this article in English, click Doctors never make mistakes.)

I december fick jag dagskirurgi (inne på morgonen och hemma på eftermiddagen) för att förbättra ett ärr som jag fick på grund av bortopererande av livmodern för två år sedan. Innan den senaste operationen ringde jag till Socialstyrelsen för att kolla om det fanns prickningar mot läkaren som skulle utföra operationen. Den som svarade förklarade att en patient hade anmält enheten, inklusive den aktuella läkaren, men att efter en undersökning blev beslutet att inga fel hade gjorts.

Inga fel gjordes. Men det önskade resultat för patienten som anmälde enheten hade inte uppnåtts på grund av beslut som fattades av dem som jobbade där.

Något gick fel, men ändå hade ingen gjort fel. Det påminde mig om min första operation när kirurgen klippt bort urinledaren under bortopererande av livmodern och man behövde fästa om urinledaren. Uppmanad av personalen och som rutin anmälde jag operationen hos Landstingens Ömsesidiga Försäkringsbolag (LÖF) för kompensation för några av de besvär som följde på grund av operationen. Men anmälan avslogs med hänvisning till att läkaren inte hade gjort fel.

Inget fel? Hur kan det vara så? Skall man skada urinledaren under bortopererande av livmodern?

Jag förstår att medicin är en konst - att det inte finns några garantier. Man kan inte alltid förutse resultatet. Ibland kan det dyka upp oväntade problem och att resultatet kan variera beroende på omdöme, skicklighet, och erfarenhet hos personen som utför operationen. Men där ligger problemet: läkare är människor, och människor gör misstag. Det är bara mänskligt. Frågan är egentligen om läkaren borde ha vetat bättre eller handlat bättre? Fattade läkaren ett beslut eller gjorde något som andra läkare i samma situation skulle anse som orimligt? Var läkaren försumlig?

När Socialstyrelsen och LÖF påstår att läkaren inte gjorde fel menar de egentligen att läkaren fattade rimliga beslut under givna villkor, trots oönskade resultat eller medföljande skador. Men det finns problem med att läkaren och andra använder förskönande omskrivningar som ”komplikation” istället för ordet ”misstag.” Det förklarar problemet med oförutsedda omständigheter eller krafter som läkaren inte kan kontrollera och frikänner därför läkaren från direkt ansvar för sina åtgärder och sina beslut. Men urinledningen klippte inte sig själv. Någon klippte av den.

Jag förstår att min situation var besvärlig och att det faktiskt inte är ovanligt att urinledningen klipps av under bortopererande av livmodern. Men det var tveklöst ett misstag. Att då inte erkänna detta gör att myten om den ofelbara läkaren bevaras.  Det hjälper inga.

Läkare lär sig aldrig ödmjukhet – för det finns inget mer ödmjukande än att titta någon i ögon och säga, ”Jag gjorde mitt bästa men jag gjorde fel. Jag ber om ursäkt.” Det får heller inte människor att acceptera att trots att man försökt göra sitt bästa händer misstag, ibland tyvärr med förfärliga konsekventer.

Jag förstår att om en läkare, mer så dock i USA, medger ett misstag är det att öppna för en stämning eller en rättegång. Men även i Sverige, där patienter inte direkt kan stämma en läkare, finns det samma motvilja hos läkare och myndigheter att oförbehållsamt erkänna och diskutera misstag i sjukvården. När jag ringde till LÖF för att kolla läkaren var kvinnan som pratade med mig lite misstänksam när jag ställde frågor. Då frågade jag henne, ”Varför är du så defensiv? Jag ställer frågor om läkaren på grund av att det inte finns ett annat sätt för att få informationen om honom.” Då kopplade om henne lite och sade, ”Ja, men några människor…,” utan att avsluta meningen.

Så snart som vi tar ned läkarna från piedestalen eller de klättrar ner själva kan vi prata lugnare om mänsklig ofullkomlighet och om patientens förväntningar, liksom om skillnaden mellan förklarliga misstag och försumlighet. Ett fel beroende på omständigheterna? Litet skadestånd. Försumlighet? Stort problem.

Det är dags att sluta låtsas att läkare aldrig klantar sig. Människor kan vara överraskande förstående när man bemöter med dem med ärlighet och respekt.

© 2012 Kvick Thoughts. All rights reserved.

(See related posts "We are not Dr. God" and Name game.)

Tuesday, March 27, 2012

"We clean ears on Thursday only."

"We clean ears on Thursday only." Children on Tuesday. Bones on Monday. Joints on Wednesday. Fevers on Friday, but only until 15.00. If your problem does not fall on the scheduled day, fuck off. Or go to the ER.

Västmanland health care at its finest.

Sunday, March 11, 2012

Facebook face-off

With the recent IPO of Facebook shares and construction of a Facebook data center in northern Sweden, it looks as if Facebook is here to stay. But I can’t say I’m staying with Facebook. It’s getting too commercial and too intrusive for my taste.

As an American who lives abroad, it’s a great way to stay in touch with far-flung family and friends. I enjoy my daily dose of friendly chatter. But Facebook is losing its charming folksiness.

My first beef is Facebook assumes a lot about me based on my age and gender, which are required information to open an account. My wall, or excuse me, “timeline” (I’m a resister) is filled with ads for arthritis medicine, weight loss products, and large-size bras even though Facebook doesn’t know my health status or weight (or so I think). But stereotyping has never stopped advertisers in the past, so why start now?

A couple months ago, I tried to update my profile. But I could no longer write what I wanted about my hobbies and interests. Everything was preset, and I could only click on icons to list my favorite books, movies, and music. I couldn’t write any free-standing information. Not wanting to be connected to these pages, I chose nothing.

But most upsetting is the meshing of personal and professional information. I recently saw a job announcement where the only way to apply for the position was through a Facebook or Google account, which automatically reveals the applicant’s age, gender, and looks (depending on the account picture). Nor did the announcement provide an email or traditional address where applicants could send documents to bypass a Facebook or Google login. For kicks, I decided to see if I could apply yet block access to potentially discriminatory information. If there was a way to do it, I couldn't figure it out.
I understand Facebook is a business and needs to make money. But it has gone too far. It’s sacrificing its reason for being to commercial interests, and I don’t know how long or how far I’m willing to cooperate. I know people who never have and never will open a Facebook account. I hope they can hold out.

I wanna talk to my peeps without worrying who’s listening in. It’s enough to drive me back to email and anonymous ads for penis enlargers.

Wednesday, January 25, 2012

Name game

I recently switched health clinics. Yesterday I visited my new clinic for the first time. On a wall in the waiting room were the happy, smiling faces of the staff, identified by first name – “Jakob,” “Kristine,” “Marie,” “Samir,” “Erik”, etc. – and job title – doctor, administrative assistant, doctor, doctor, nurse, etc.

Self-reference by first name only is supposed to convey friendliness and feel less intimidating for patients, I assume. But I think it conveys a lack of gravitas I find distressing when it comes to my health. I appreciate friendliness and service with a smile; but both a first and a last name convey a professionalism I find reassuring. When a doctor or nurse uses his full name when introducing himself I feel like he's giving me his complete attention and putting his entire reputation on the line for me. This person is saying “I’m completely committed to your care.”

Although my former doctor put a perfunctory “Dr.” before his first name, i.e. “Dr. Harold,” when he phoned with test results or treatment options, this didn’t cut it either. It’s the way someone talks to children or how people refer to doctors on radio or TV talk shows: I am not seven years old and you are not a media personality. I want to be approached as an adult peer, and I want my medical practitioner to present herself using her first and last name as in any professional relationship: “This is Claris Parnell from the City Health Clinic. I’m calling about….” Or, more traditionally, “This is Dr. Parnell from the City Health Clinic.”

But don’t try and be my “buddy.”  It’s supposed to feel friendly, but I find it forced and phony, and presumptuous. Given a choice, who would you trust: Dr. Hibbert or Dr. Nick?

© 2012 Kvick Thoughts. All rights reserved.

Tuesday, January 17, 2012

Doctors never make mistakes

(To read this article in Swedish, click Läkare är inte ofelbara.)

I had day surgery (in and out the same day) in December to repair a scar from a hysterectomy
about two years ago. Before this most recent surgery, I called Socialstyrelsen (National Board of Health and Welfare) to check the record of the doctor who would be doing the operation. I was told there had been a patient complaint against staff in his unit, including him, but that the complaint had been investigated and it had been determined no mistakes had been made.

No mistakes were made. Yet the desired outcome for the patient who filed the complaint had not been achieved as a consequence of their decisions. Something had gone wrong, but no errors had occurred. It reminded me of my first operation two years ago when the surgeon cut a ureter during the hysterectomy and it had to be reattached. As a matter of routine, I filed an insurance claim with Landstingens Ömsesidiga Försäkringsbolag, LÖF (patient insurance bureau) for financial compensation for some of the ensuing difficulties. But my claim was denied because the doctor had done nothing wrong.

Done nothing wrong? How can this be? Are you supposed to damage the patient’s urinary tract during a hysterectomy?

I know medicine is an art – nothing is guaranteed, outcomes are not always predictable, difficult, unforeseen circumstances are possible, and results can vary depending on the judgment, skill, and experience of the individual practitioner. But there's the rub: doctors are people, and people make mistakes. That’s the human condition. The real question is: should the doctor have known or done better? Did the doctor make a decision or do something other doctors in the same situation would consider unreasonable? Was the doctor negligent?

When Socialstyrelsen and LÖF say the doctor did not make a mistake, what they really mean is the doctor followed a reasonable course of action under the circumstances despite a negative outcome or collateral damage. But the problem is when doctors and others use euphemisms like “complication” instead of the word “mistake,” it ascribes the outcome to unforeseen circumstances or forces over which the doctor had no control and thereby absolves the doctor from direct responsibility for her actions. My ureter did not cut itself. Someone cut it for me.

I’m aware that in my case the circumstances were difficult and that, in fact, to slice a ureter during a hysterectomy is not uncommon. Nevertheless, a mistake was made and by not acknowledging that, we perpetuate the myth that doctors don’t make mistakes when they obviously do. This is a disservice for everyone. It fails to teach doctors humility – there’s nothing more humbling than looking someone in the eye and saying “I did my best, but I made a mistake. I’m sorry.” And it does nothing to help people accept the fact that despite a doctor’s best efforts, mistakes do happen, sometimes, unfortunately, with dire consequences.

I realize that especially in the United States for a doctor to admit a mistake is, for many reasons, to invite a lawsuit. But even in Sweden, where patients cannot sue doctors directly, you see the same reluctance in doctors and regulatory authorities to openly acknowledge and discuss mistakes in medical treatment. When I called Socialstyrelsen to check the record of my most recent surgeon, the woman I spoke with was vaguely hostile and I flat out asked her, “Why are you so defensive? I’m just asking about this doctor and there is no other way to get information.” She relaxed a little and said, “Well, some people…” and trailed off.

The sooner we take doctors off their pedestal, or they climb down themselves, the sooner we can talk more calmly about human fallibility and patient expectations, and the difference between understandable mistakes and negligence. Circumstantial mistake? Small penalty. Negligence? Big problem.

But let’s stop pretending doctors never flub up. People can be surprisingly understanding when talked to honestly and respectfully.

© 2012 Kvick Thoughts. All rights reserved.

(See related posts "We are not Dr. God" and Name game.)