And Progressivism destroys diagnostic medicine

I am not a medical doctor.  I have, however, attended classes with and have taught pre-med students.  I also know some medical doctors quite well.

The process of diagnostic medicine is very similar to the process of performing a root cause failure analysis.

You evaluate the evidence presented and using fundamental knowledge of science/engineering/medicine, identify why whatever went wrong went wrong.  Then you apply your knowledge to fix it.

If you showed me a part that broke, there are some things I have to know.  What was the part and how was it used in service.  Then I can look at the fracture surface and identify overload or fatigue.  I can identify if that was ductile or brittle failure, or rotating bending fatigue.  I can look for the origin of the fracture to see if it was a material defect or machining defect.  Was the heat treat done correctly?

If you don’t tell me everything I need to know or give me incorrect information, I can’t do a proper root cause failure analysis and provide a correct solution.

Diagnostic medicine is the same.

For the moment, Progressivism hasn’t hit failure analysis.

I can’t say the same for medicine.

Blurred lines: A pregnant man’s tragedy tests gender notions

Right away, I am seeing a problem here.  With all due respect to the LGBT community, a man cannot get pregnant.

When the man arrived at the hospital with severe abdominal pains, a nurse didn’t consider it an emergency, noting that he was obese and had stopped taking blood pressure medicines. In reality, he was pregnant — a transgender man in labor that was about to end in a stillbirth.

The tragic case, described in Wednesday’s New England Journal of Medicine, points to larger issues about assigning labels or making assumptions in a society increasingly confronting gender variations in sports , entertainment and government . In medicine, there’s a similar danger of missing diseases such as sickle cell and cystic fibrosis that largely affect specific racial groups, the authors write.

The way the article is written, they want to put the onus on the medical community to be more sensitive.

Again, with all due respect to the LGBT community, fuck that noise.

The onus should be on the patient to say “by the way, I’m trans with no bottom surgery, and I have unprotected sex with men.”

To put the onus on the medical community is only going to increase costs and result in more misses.

We know as a medical fact that strokes and heart attacks present differently in women than men.  In the critical minutes or seconds of diagnosis, we can’t have doctors wasting time chasing red herrings because they have incorrect information.

When I go to the hospital with severe abdominal pain, I tell the doctor I have inflammatory bowel disease.  It aids in his diagnosis.  Maybe I have appendicitis, maybe I have a colonic ulcer.

What I don’t need is the doctor to look at me, guess that I may be one of the fractions of a percent of people who is trans, and give me a urine test for pregnancy and start to check for an ectopic pregnancy while my bowel starts leaking into my peritoneal cavity.

Furthermore, doing additional testing to all patients in the unlikely event a patient is trans, is just going to add unnecessary cost to healthcare.

“The point is not what’s happened to this particular individual but this is an example of what happens to transgender people interacting with the health care system,” said the lead author, Dr. Daphna Stroumsa of the University of Michigan, Ann Arbor.

“He was rightly classified as a man” in the medical records and appears masculine, Stroumsa said. “But that classification threw us off from considering his actual medical needs.”

No, he was wrongly classified as a man if the classification threw them off from considering her actual needs.

I don’t care how you look, but medical paperwork should be factually accurate.  If you are trans, your paperwork should say that and give information as to just how trans you are, i.g., hormones, top surgery, bottom surgery, etc.  Doctors need to know this and depriving them of that information risks the patient’s life.

“But… but… but… patient rights.”

Let me be blunt.  I don’t go around letting random stick their fingers in my asshole.  That doesn’t turn me on.  When you have IBS, and the doctor says he needs to do a rectal, you let him do it.  You can’t keep secrets from your doctor and get good treatment at the same time.

The 32-year-old patient told the nurse he was transgender when he arrived at the emergency room and his electronic medical record listed him as male.

So why was male on his records if he said he was trans?  Why was this not immediately communicated?

He hadn’t had a period in several years and had been taking testosterone, a hormone that has masculinizing effects and can decrease ovulation and menstruation. But he quit taking the hormone and blood pressure medication after he lost insurance.

And without the testosterone, he de-transitioned and got pregnant.

Again, important information.

A home pregnancy test was positive and he said he had “peed himself” — a possible sign of ruptured membranes and labor. A nurse ordered a pregnancy test but considered him stable and his problems non-urgent.

Several hours later, a doctor evaluated him and the hospital test confirmed pregnancy. An ultrasound showed unclear signs of fetal heart activity, and an exam revealed that part of the umbilical cord had slipped into the birth canal. Doctors prepared to do an emergency cesarean delivery, but in the operating room no fetal heartbeat was heard. Moments later, the man delivered a stillborn baby.

So we have incorrect information and bad communication leading to a negative outcome.

A woman showing up with similar symptoms “would almost surely have been triaged and evaluated more urgently for pregnancy-related problems,” the authors wrote.

“It’s a very upsetting incident, it’s a tragic outcome,” said Dr. Tamara Wexler, a hormone specialist at NYU Langone Medical Center.

The article is probably right if she looked like a woman her case would have been addressed correctly.

The problem here is that medicine and Progressiveness have created a cognitive dissonance that they now want to undo.

Trans Activists: “A trans-man is a man.  That is a man’s vagina.  You need to treat him just like any other man, to do otherwise is transphobic.”

Also Trans Activists: “A trans-man is a woman and you need to be acutely aware of his female medical needs.  To do otherwise is not sensitive and transphobic.”

Well, shit.  Now I am all confused.

“Medical training should include exposure to transgender patients” so health workers are better able to meet their needs, Wexler said. “A lot of doctors who are practicing didn’t have that in their training” but can still learn from such patients now.

I’m all for training, but there is only so much time in the day and just how many patients are like this in the country?

Nic Rider, a transgender health specialist and psychologist at the University of Minnesota, said training isn’t enough.

“There are implicit biases that need to be addressed,” Rider said.

Of course there is… there is always some way to blame society as a whole and say that no amount of progress is ever good enough when you are a Progressive.

Health records may use male/female templates for gender but “it doesn’t mean that we just throw out critical thinking or think about how humans are diverse,” Rider said.

That is unscientific, ideological bullshit.

Male and female mean something.  If a woman has to get up in the middle of the night to pee a lot, you don’t normally give her a prostate exam.  He may look like a woman, but it is important that his doctor knows he still has a prostate.

Words have meaning.

The case is horrifying but “not terribly surprising,” said Gillian Branstetter, a spokeswoman for an advocacy group, the National Center for Transgender Equality in Washington.

Actually, the idea of a pregnant man is terribly surprising.

Transgender people often run into problems getting gender-specific health care such as cervical cancer screening, birth control and prostate cancer screenings.

What did I just say?

More needs to be done to improve medical awareness and recognition of diversity because “the consequences can be so dire, as this case shows,” Branstetter said.

No.  This is bullshit.

Doctors don’t need more diversity training.  Doctors don’t need to order pap smears for every man just in case they might be trans.

The patents paperwork needs to be crystal clear that she is female, still has her female anatomy and the records of care on that.

I would go so far as to suggest that not just the paperwork be accurate but that trans people start wearing medical bracelets declaring that they are trans, and possibly the degree to which they are trans.

There are drug interactions with hormones.  Men and women respond differently to different drugs, especially anesthesia.

The doctors need an immediate clue that what they are looking at is a woman who looks like a man, is anatomically intact, and is on supplemental testosterone.  Then they can make a more accurate diagnosis and prescribe a better treatment.

This is why I have such an issue with the gender rules on drivers licenses.

If you want to accommodate trans people on government ID, don’t just have a category for ‘sex’ which changes, have ‘sex’ and ‘gender presentation’ and make sex biologically accurate.

Then in a medical emergency, the information is available.

This is going to become more important in the future and I can only imagine the medical malpractice cases that come out of it.

“My brother died of a treatable condition. I’m suing you.”

“Your brother died because everything said your brother was a male, but he was a female having the typical signs for a heart attack in a woman but we missed them because everything said he was a male.  We misdiagnosed because we were misinformed.’

“You’re a transphobic bigot.”

And now some doctor not just goes broke but has his career ruined for not being woke.

The onus needs to be on trans patients to be 100% honest and communicate fully and for medical paperwork to be 100% anatomically and physiologically correct.

If it’s not, more bad things will happen.

Progressivism needs to leave medicine alone or more suffering and death will occur.

 

 

14 Replies to “And Progressivism destroys diagnostic medicine”

  1. Once more, into the breach, with the “party of science.” I’ve been responding to money pleas from my alma mater (MIT) that I won’t give while they’re pushing anti-scientific b.s. All this proves is that Prager is right–the left destroys everyting it touches.

    YMMV

  2. Fast forward a few years, imagine you are a smart high schooler with an interest in medicine and a strong desire to help people. You bust your hump to get get into med school, spend eight years completing some of the toughest college coursework imaginable plus years as a virtually unpaid intern, and finally get your license to practice medicine. Now “Medicare for all none” dictates a fee schedule not much higher than your neighbor who is a plumber. LGBTQ organizations wait for any excuse to sue you into perpetual poverty for questioning the identity (assumed) of a patient. Patients lie to you about their fundamental anatomy then sue you into perpetual poverty if the treatment you prescribe fails. You wonder why you didn’t go to law school, and the rest of us wonder where the doctors went.

    1. @Nuke Road Warrior: Actually, plumbers make pretty good money. Around here, a major plumbing job (new construction, or full refit/replacement) could cost $80-150/hour (labor only; supplies are extra) for a qualified plumber. That’s close to lawyer-level rates!

      It’s very possible that a full-time plumber with a consistent workload brings home considerably more than a doctor who finds him- or herself limited to Medicare patients. And does it without the student loans.

      1. My oldest daughter (just turned thirteen) has been expressing interest in welding and other forms of metalwork for a while now… I don’t want to be the kind of parent who decides their kid’s career a decade before they graduate high school (learned that the hard way, thanks mom and dad), but I’m totally on board with her pursuing a skilled trade instead of a four-year debt certificate degree.

  3. My husband is a transgender man and the mother of our two children. When he goes into the hospital for emergency medical care (there’s some persistent respiratory issues that have bugger all to do with gender or sex) he makes it a point to let his care providers know he’s female sex and male gender. For exactly the same reason anyone with half an ounce of sense would inform their medical providers know about any other status that could affect their care…

    I really, really, really hate that the LGBT “community” has been completely co-opted by fringe radicals that seem to think that if they whinge hard enough on Twitter, then reality itself will magically transform into what they want it to be.

    1. I was kind of hoping you would chime in on this. I’m glad for your family’s sake your husband acts reasonably when it comes to health care.

      1. Most of the transgender folks in my circle of acquaintances aren’t nearly so idiotic as to withhold information like this from their doctors.

        Okay, sure, if they’re just popping into the local after-hours urgent care to get some stitches on a laceration, it probably won’t come up. But when dealing with some serious? Yeah, denying pertinent information to your doctor is dumb as f—k.

        We all need to keep in mind that the vocal, loud-mouth, “woke” uber alles types that we so often see in the media are not truly representative of the “community” they claim to represent.

  4. “There are implicit biases that need to be addressed,” Rider said.

    Agreed, but the answer is not to treat everyone as if they’re trans-gender on the off-chance (what is it, 0.4% of the population) the person in front of you is trans.

    If it’s “insensitive and trans-phobic” to assume the man in front of you is in physiological fact a man, how is it not insensitive and hetero-phobic (or cis-phobic, whatever the “cis” means) to assume every man who comes in is a woman who just looks like a man? The solution to “implicit bias” is NOT to replace it with systemic bias in the other direction.

    In either case, it slows diagnoses during a medical crisis in which seconds could count. When you have to check if a woman has a prostate issue, that’s several minutes a blown Fallopian tube from an ectopic pregnancy is going undiagnosed and untreated. And when you have to check if a man might be having an ectopic pregnancy, that’s several minutes that prostate issues might be going unnoticed.

    And all of that is just wasting time if the real issue is a burst appendix in any gender.

    Much of the onus is and should rightly be on the patient to assist in the diagnostic process by providing complete and accurate information (to the best of his/her ability). Any mistakes made based on false or misleading information the patient provided, are the fault of the patient.

    Do doctors need training for trans-gender patients? Maybe, but we’re talking a one-hour (tops) lecture: “Hey, these people are out there. Be aware of that. It’s a possibility if your diagnoses and treatments aren’t going normally, or if the symptoms aren’t making sense. And watch out for hormone-drug interactions in these individuals.”

    Medical students are smart; they wouldn’t be there otherwise. Remind them now and then that “trans-gender” a thing, and they’ll figure out the rest. That’s all the “training” they need.

  5. ““He was rightly classified as a man” in the medical records and appears masculine…”

    She still had the primary sexual characteristics necessary for pregnancy. A two-second check would have confirmed that.

    1. @crawford421: “Rightly”

      Rightly to whom? Not to the doctors, who — lacking accurate biological and physiological information — were not able to correctly diagnose the issue. Nor to the infant, who might have been saved by more timely intervention.

      “He” was only “rightly” classified as a man in the eyes of in-your-face trans-activists, to whom using correct pronouns is more important than saving lives.

      When saving lives becomes a distant second concern to calling a patient by politically-correct pronouns, “Progressivism” has effectively killed medicine.

      1. It’s an endless source of confusion for me that so many of the militant transgender activists and so many of their most vocal critics constantly conflate sex with gender.

        I assume the critics are just ill-informed, but you’d think that the militant transgender activists would be aware of the distinction. I mean… That’s kinda the whole reason a person transitions, y’know?

        1. I’ve found that there’s two types of activist.

          The first just honestly wants to be legally and socially left alone to be themselves and do their thing.

          The second revels in the attention, and wants people to PAY ATTENTION TO THEM!!!!! and make the mundanes uncomfortable.

          1. The dirty secret of third-wave feminism is that it’s entirely subsidized by Daddy’s Money and entirely fueled by I Hate You Daddy! sentiment. Most militant activists are “cosplay revolutionaries,” who just really want their parents to notice them.

            I’m pushing forty. I remember a time when homosexuality was still taboo, bisexuality was considered a myth, and HIV/AIDS was being dismissed by the government as “f*g cancer.” Matthew Shepard was murdered while I was in high school, for heaven’s sake. “Sodomy laws” were on the books in a majority of states making consensual homosexual sex between consenting adults (in private!) felonious!

            Nowadays, not only is gay sex and gay marriage legal… It’s basically completely unremarkable. We’re here, we’re queer, and everybody got used to it.

            But the “cosplay revolution” isn’t actually happy with the fact that the battle for LGBT rights is over and we won. Oh no, because then they don’t have any “revolution” to join… Yeah, sure, they could join a group that wants to make real change (like, say, combating the scourge of fatherless-ness in the black urban community) but that has too much risk. Waging a “revolution” is so much safer when everyone already agrees with you.

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