Saturday, March 6, 2010

An open letter to Roger Starner Jones, MD, Department of Emergency Medicine, the University of Mississippi Medical Center



Dear Dr. Jones:

Regrettably, your letter of August 23, 2009 to the editor of the Clarion-Ledger in Jackson, MS has gone viral. I say regrettably because as a fellow physician I find your views particularly offensive. Yes, people do smoke. They overindulge in alcohol. They don't eat properly. And they don't take their medications. But it is our duty--no, it is our privilege--to provide care to those who you label as "the careless," not to pass judgment on them as you have done. And I feel compelled to add that your description of the young woman and your use of the term "culture crisis" have undeniably racist overtones and do a disservice to our profession. Badly done, sir.

Craig Siegel, MD, FACC

Link to Dr. Jones's letter:

192 comments:

  1. Hello Dr. Siegel,
    I am so glad to read a response from a member of the medical community that parallels my thoughts. I have only recently become aware of this letter by Dr. Jones, but the ensuing email dialogue between myself and "friends" forces me to face that too many individuals prefer to think with their fears, suspicions, frustrations - anything but their heads. Perfect conditions for scapegoating, and particularly dangerous when exploited by someone in his capacity. How fortunate that your open letter is readily linked in a Google search of his name. Julie Hershey

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  2. Dr Siegel,
    I did not see in Dr Jones letter where he mentioned the race of his patient. Why did you assume this patient to be a minority? I grew up with little money and my Parents fed us homegrown vegtables and homemade breads because they could not afford store bought foods. Today it is the fast foods that are the cheapest foods and many Americans are not educated to know that this is killing them. However your world as a cardiologist is far different than a ER physician. You don't see those that abuse the system. Those you see need interventions on initial contact. ER physicians are used as Primary Care Physians everyday for things as minor as headaches, fevers, toothaches, and heartburn. The ER system is sometimes overwhelmed with non emergent patients. This is due to lack of education and a culture crisis when this is the norm to these families and will be for the children of these families. This sence of entitlement that leads people to believe that just because they are born Americans that they should be secured money for food, cigarettes, and free health care is foolish. Our health care system will continue to suffer on the backs of tax payers both with private paying or socialized medicine until we can fix this underlying "culture crisis"

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  3. Personally, i did not see where race was brought up at all. I agree that the system is abused.

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  4. To Dr. Siegel and his supporters,

    My interpretation of Dr. Jones' letter was not that he was questioning why he, as a physician, should be required to treat the patient with careless tendencies and poor choices, but rather why he, as a taxpayer, should be forced to be financially responsible for this patient's careless tendencies and poor choices when the public assistance being abused to pay for the care is funded by his tax dollars.

    I believe everyone is entitled to make their own choices and live their lives as they see fit; however, it would be an understatement to say that I am disappointed when I see how hard my family works to make an honest living and provide for our own, and then I see others, who are quite capable of providing for their own, will quit their jobs and live off of public assistance for their income, food, and healthcare, simply because it is easier than maintaining employment. Believe me, I am ashamed to say that I personally know people who have done this, and I angers me to know that my family is working so these people can benefit from the programs that are being paid by our state and federal taxes.

    Should people be denied healthcare because they abuse the system? No. Should they be denied public assistance because they abuse the system? Yes. Should they be punished for their abuse and contributions to the failure of the system? YES!

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  5. I agree that this client he saw does not get the picture, but one anecdotal story does not make a culture crisis. My wife and I both work full-time plus and we can not afford the $1500 per month a health care coverage would cost. I think ...the Doctor needs to think about he fact the $200,000.00 he borrowed to cover the cost of his education was provided for and backed by the US Government and US Taxpayers. We will foot the bill over the 20 years he repays it. His first job out will be at a salary of approximately $150,000 per year (5 times the national average). If he works in a rural area for 5 years the US Government will 'forgive" his debt (meaning we the taxpayer will pay his education for him) while he continues to earn 5 times the national average in wages. Roger Starner Jones, MD should be happy he lives in a country that will subsidize his education and allow his to earn a fantastic salary. By the way, the culture crisis he identified is created by MADISON AVENUE and Fed by WALLSTREET and the Banks the American TaxPayer Bailed Out. It is the engine that drives our economy. Obama had nothing to do with it. I would like to blame George W. Bush, but he had nothing to do with it either. Neither did Clinton, Bush 1 or Ronald Reagan. Every one who buys a brand name pair of shoes, a shirt, a specific kind of beer because they like the advertisement is responsible for this culture that values materials over life. Harvey Norris, MSW, LCSW

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  6. If that patient can afford all of those items and FAILS to pay for health insurance, that is a crime. Why should I pay for their health care? It is not because they are poor. It is because they make poor choices when they spend their money.

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  7. I am by no means insulated from the failures of our healthcare system. I routinely provide care to the indigent, the uninsured, and those who Dr. Jones dismissively labels "the careless." I, too, am a taxpayer, but first and foremost I am a physician who took a sacred oath over twenty years ago, an oath which still has relevance today. Our primary responsibility must always be to the patients under our care. Anything less does a disservice to ourselves and to our profession.

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  8. Anonymous stated "However your world as a cardiologist is far different than a ER physician. You don't see those that abuse the system. Those you see need interventions on initial contact. ER physicians are used as Primary Care Physians everyday for things as minor as headaches, fevers, toothaches, and heartburn. The ER system is sometimes overwhelmed with non emergent patients. This is due to lack of education and a culture crisis when this is the norm to these families and will be for the children of these families." The previous President suggested that Americans should use the E.R. for these purposes as a rationale for vetoing health care:
    http://leisureguy.wordpress.com/2007/08/15/bush-for-healthcare-go-to-the-emergency-room/

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  9. Hi, my name is Steve. I work, and my wages pay for my healthcare. My efforts keep me healthy. Why should I pay for someone elses obvious abuse of the system? It is said a society is judged by how it treats the less fortunate members of that society. As I scrape by watching more and more of my paycheck being taken in taxes and fees for social services that won't be available to me for at least another thirty years and I watch more of the money I do get to keep buy less and less as the cost for everything rises. Am I among the unfortunate or should I feel priveleged as I work each day to improve my situation in life while providing for the welfare of people obviously abusing a system? Shall I be demonized for my feelings that I have had about our welfare system since I started working when I was 13? Oh and I'm white so go ahead call me a racist while your at it folks.

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  10. I am a paramedic in a rural area of Alabama. I wholeheartedly agree with Dr. Jones. I do not believe that his comments were "racist.". I do believe that his comments were describing a large part of society whose ideas are fueled by the perceptions that today's culture have instilled in them. That the world "owes them something." for the most part these citizens I am describing don't care about maintaining their health if it costs them anything, they are only concerned about the luxuries that they can possess to impress the other members that share their came cultural views.

    I

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  11. I found your blog after searching on Google for Dr. Jones, to see if the letter I just saw was real. While I see that you and I disagree on the actual letter (since I agree with Dr. Jones) I see it as a larger picture than just health care.

    I work in a college setting at a school that is towards the high end of the cost scale. I see kids all the time who literally beg for more financial aid, and I feel for them. Then I find out that they own a nicer car than I do, have the same smart-phone that I do (that I only have because I use it to do my job more efficiently and the school pays for it), and have other name brand items that are not necessities. Many (not all) treat the work-study program as free cash. I can't tell you how many times students neglect their duties and think they should be allowed to do their own thing instead of working. It's work-so that you can pay to-study; but many do not see it that way. But, I digress. Some things in life need to be worth sacrificing for. I could live in a bigger house, but I have 2 young children that I plan to send to college and a wife that I'd like to grow old comfortably with in retirement in 30+ years.

    I didn't think that Dr. Jones was saying the individual he saw in the ER shouldn't be treated. But the cumulative effect of people putting frivolous possessions (the tattoos, personal electronics, jewelry, name brand apparel, etc.) ahead of an individual's basic needs ends up costing us all more.

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  12. ROGER STARNER JONES, MD gladly lend a helping hand to our neighbors in need, especially when they've fallen. After we've hoisted them up, we'll let them lean on us until they can stand. After that we expect them to carry their weight, and if it's too much -- stop eating at McDonalds.

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  13. You are way off base Siegel. Yes, we took the Hippocratic Oath, but nowhere in it did it say we revoke our 1st Amendment right or the ability to think for ourselves. Dr. Jones clearly saw one of probably many cases of people abusing and blatantly raping the "system" and was pushed to the point where he felt compelled to say something. Good for him!

    The fact that you assume the patient is a minority (by your assertion that Jones' letter had "racist overtones") simply because he mentions she had a gold tooth and listened to R&B music is a disgrace. YOU are doing the disservice to the profession. As my father once said, "Those who are first to cry racism are often times the biggest racists of all."

    -Dr. J.D. Goldmeyer

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    1. Dr. Siegel never mentioned a "gold tooth" or "R&B music" he said "racial overtones". Goldmeyer you are the person who made that equivocation. You also implied that Dr. Siegel is a racist through a cowardly quote from your father. Bad form and highly unprofessional. Thank you for posting your name, now decent folks know of at least one more doctor to avoid.

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  14. I've been in health care for 10 years. I've seen the patient who comes into the office and hands me that Medicaid card wearing Juicy pants, nails done, smart phone, etc. Dr. Jones was merely pointing out the obvious, not racial. I completely perceived this as him pointing out the flaws in the system that allows this person to "qualify" for state insurance but affords the luxuries in life. Not meaning that some people don't deserve luxuries now and then, but don't ask for hand outs at the same time you pay for that pack of cigarettes.

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    1. What you have failed to recognize is that these "expensive" cloths can be purchased used for only a few dollars at thrift stores. Many smart phones today are free with a cell phone contract and many folks find cell phones less expensive than the traditional land lines, so they go with the cheaper cell phone. And you are really complaining about women who care enough about their appearance to make sure their nails are done? How do you know they paid a professional? How do you know if they did their own nails or not? Would it make you happier if they looked horrible and were wearing rags? The arrogance of health professionals such as yourself is the real "cultural crisis". People put their lives in your hands.

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  15. The point is that as physicians we should be held to a higher standard. There is no place in medicine for the judgmental views expressed in Dr. Jones's letter. When we decide to castigate the "careless," where exactly do we draw the line? The celebrity who develops throat cancer because he smoked and drank too much? The college student who contracts an STD from unprotected sex? Or what about my HIV patient who required drainage of a half liter of bloody fluid from around his heart shortly before midnight?

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    1. Thank you for being a good doctor, Dr. Seigel.

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  16. Dr. Seigel,

    Your condescending attitude toward Dr. Jones is only part of the problem with your comments. "Physician heal thyself!"

    I found it interesting that you decided to play the race card. Mr. Jones does not tell us the race of the patient, but you decided that he must be talking about a minority. Guess what? There are plenty of caucasians who have gold teeth, tatoos and who listen to R&B music. Your comment indicates you are more likely to have racist attitudes than Dr. Jones.

    He never says that people shouldn't have access to health care or support for their health care. He simply points out the truth. There are a lot of people out there who spend money on things they shouldn't when they can't afford to purchase things they NEED on their own.

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  17. ARE MOST OF YOU READING DR. SIEGEL'S RESPONSE? The point is that it isn't a doctors roll to pass judgment on his patients. His roll is to provide quality health care to everyone, regardless of their attire, race, creed etc. We are all Americans at the end of the day, let's treat each other with some damn dignity.

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  18. Oh Jesus Goldmeyer, do you really think he was describing an old white woman? It's amazing how everyone just beats around the bush.

    The point is, who cares about what the patient was wearing or does with their life? That isn't important at all. In fact, it's not even important whether or not they milk the system, because that's beyond the scope of a doctors responsibility.

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  19. I enjoyed reading your "about me" information. I'm a swim mom and love nothing more than spending time at the pool while watching my boys swim. It's truly a beautiful sport-almost like art actually. My oldest son is slow relatively speaking, but he's so technically "perfect" that it's almost eerie. My middle son has the most beautifully poetic butterfly I've ever seen, and my youngest is truly a competitor at heart. He's like a living breathing racing machine; he takes my breathe away. That is not the purpose of my response though.

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  20. After reading Dr. Jones's letter, your blog, and the responses, I still think Dr. Jones is relatively correct and appropriate in his comments. I did not read where he mentioned race, nor did I read that he refused services. He merely expressed a concern about a society (a society funded by us) that would pay for this individual's medical care (something I consider a necessity) while the individual is able to fund (in one way or another) life's luxuries. I'm not stating that medical care should be denied, but I, like Mr. Jones, get angry when I witness similar behavior.

    I am a teacher-a hardworking teacher who is also in the process of becoming a single mother. I've "followed all the rules", and I still get by for my children. As I mentioned, my boys swim, and I'm sure you're aware that it is not a cheap sport. I do not expect handouts so that my boys can continue to do something they and I love. I work extra. In addition to working during the day, I have taken on extra tutoring and have even looked into working some other type of part time job-waiting tables or working in a bookstore or the like. I have a master's degree in education, yet I am not above working in the food service industry to fund the necessities and luxuries that my family needs and wants. Good thing too, because I doubt very seriously that I'd qualify for any assistance whatsoever.

    Let me tell you it's tight too. After I pay bills-including my own health insurance and the like-as well as for a few of the things we want, I have very little left for extras. I definitely don't have the money for tattoos-I'm fully aware of how much they cost too, because I DO have a small one. I could not afford another one at this time if I wanted.

    Unlike many students who receive free-lunch and free school supplies (payed for by me, because their parents cannot or won't send in supplies) yet can attend school dressed to the nines, my boys are limited in the name brand clothing they wear. They have some, but very little. We are not flashy or showy. Life is good and all, but it is tight at this time. We work and we save for needs and wants. We budget our resources. It is my belief that is the American way.

    As a special education teacher I also fill out many social security supplemental request forms for students who have mild disabilities such as learning disabilities or adhd. The purpose of this is to help families who are not able to work to provide for family needs because of a child's disabilities. I've yet to meet a parent who really, honestly cannot work because of a child's disability. Not only am I a special education teacher, but I have two sons with adhd and one of those has a learning disability. Again, I work; they work; and we get by. We do not ask for handouts. On the flip side, I've had parents apply for this help, because their children truly did have disabilities that created a hardship for the family, yet they were unable to get supplemental aide. The reason is because the mother made too much money. She refused to give up her night job stocking shelves at Wal-Mart in order to get that help. She wanted to do her part-but still needed more. She never got it but refused to quit her job. It's sad.

    To offer handouts repeatedly is actually more racist and demeaning than requiring that an individual step up and take care of his own needs as much as he is able. Otherwise, we're telling the individual that he is not capable and needs us to protect and save him. We are telling the individual that we are the protector, because we are better and more able than he is. That to me is much more demeaning and breeds contempt and self-loathing. It is not good for any of the parties involved.

    Lastly, darn straight I get angry about people who abuse the system. It leaves less for those who really DO need our help. I'm all about serving my fellow man, but man should help himself first.

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  21. Oh my GOD people! He is not saying not to care for the careless....merely that they should NOT have free health care! Is that REALLY so racist?!?! Is it really soooo horrible that SOMEONE takes the initiative to force some prorities on the American people! If you can afford a new car....you can afford health insurance! If you can afford a gold tooth, Nikes, an i-phone, McDonald's EVERY night.....HEALTH INSURANCE!! What the hell has come over you people? Your boyfriend sells drugs for a living and you still live off the government....you know what Im going to say! And not one IOTA of myself has brought a "race card" to the table! Nor have I said not to treat these people....treat them....then charge them!

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  22. Mr. Seigel,

    I too am a physician who practices Surgery in an upper class area of the US. I don't necessarily believe that Mr. Jones speaks only to those people who have multiple tattoo's or wear expensive clothing while ignoring their own health.

    In my practice, I see many self employed artists, traders, financial analysts, contractors, etc whose yearly income far exceeds my own. While they have the financial resources to do so, many of them do not carry personal health insurance. To be frank, I'm not sure that I can blame them. Most wealthy people became wealthy by managing their money very well (though there are the few that were lucky!). If one incorporates themselves, or otherwise shelters their true worth, and draws a "salary", there is nothing to take when the hospital/physician group sends the collectors knocking on their door. They know that if they walk into an ED anywhere in the country that they will be seen without regard for ability to pay. And often, pay they do not.

    The culture "crisis" that Mr. Jones refers to is the lack of personal responsibility that penetrates our society. People beleive that it is their given right as a United States citizen to recieve "bailouts" in times of need or misfortune. That sentiment is not exclusive to those earning the US median salary or below. Surely everyone remembers the (continuing) bailout of Wall Street. Thousands of people made tens of millions of dollars from their companies only to have their company go broke and require governmental assistance. Did those people have to give their exorbitant bonuses back? Absolutely not. Did the companies stay afloat? Not all, but most.

    It's this lack of personal and societal responsibility that Mr. Jones alludes too. Perhaps his choice of patient to use as an example could have been less stereotypical, but his point is a good one.

    I see a clear parallel between the people Dr. Jones writes about and the individuals in my practice. The bottom line is that in the US, you will receive excellent health care-whether you pay for it or not. So, it is a very low priority for some to ensure that they take their HTN meds, or get a colonoscopy, or have insurance. Because those outpatient settings require co-payments and the like.

    I'll continue to operate on un-insured/inadequately insured patients because it is the right thing to do. But, I'll also continue to be frustrated by the lack of respect and sense of entitlement that many patients display toward me and my collegues. Hopefully none of them will sue me for my efforts. I wonder if my lawyer would be willing to work for free if I get sued? I think not.

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  23. Just because Dr. Jones is a physician does not mean that he is brain dead to all that goes on around him and can't have an opinion about it. He is right! I was brought up poor so we did not have chips and soft drinks in our house. We could not afford them. Turns out we were better off eating our home grown eggs, milk, butter, fruits and vegetables. What a good break for us that we were poor. We did not have health insurance and paid to see the doctor when necessary. My father would never have dreamed of asking for anything free. I am proud of him.

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  24. From a fellow swimmer and Texan, I appreciated reading your reply. The causes of our current healthcare situation are so vast and complex that any attempt to try and reduce it to one person's experience with a handful of patients is insulting and misleading and ultimately distorts the problem and interferes with sincere efforts to find solutions.

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  25. I think you missed the point of the original letter: he's concerned because this woman has no problem blowing her money on a cell phone, expensive shoes, a gold tooth, cigarettes, etc.--yet she apparently "can't afford" healthcare. As a responsible taxpayer who is probably footing her bill, I'm pretty livid about situations like that.

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  26. Last time I checked, Health Insurance is considerably more expensive than a gold tooth, cheesy tattoos, an iphone (with a ringtone) and some pretty white gym shoes.

    In fact, fixing a tooth properly with a porcelain cap costs more than some tacky gold garbage. I don't see how this guy is abusing the system. To me he looks like he's ignorant and barely capable of wiping his ass, much less purchasing and maintaining health insurance. He is exactly the type of person who needs our help, and we only have ourselves to blame.

    We are producing uneducated people in our society that just don't know how to take care of themselves. We insist that mothers don't have abortions and have their kids, and actually scare them into it by throwing their religion at them, but we don't help those teen mothers take care of those kids, because we can't 'afford' it. Then when those kids grow up, they become either soldiers to fight and die for our leader's wallets or become just ignorant robots programmed by the corporate Wall Street marketing monster to live only to buy a bunch of worthless toy-crap at the mall.

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  27. You're response is faulty as you assume Dr. Jones is a racist and you assume that Dr. Jones gave this patient a lesser quality of care because she was on Medicaid.

    I believe the reason why the doctor gave you the background of his occupation and this patient was so the reader would feel his opinion a valid one and not just a rant. Who would have a better idea of the type of abuse the health care system is put under daily? A doctor who actually works in the hospital, specifically the emergency room or just a private citizen. I would feel the doctor's anecdote a more practical and factual view of the emergency room than that of a private citizen who may have had a bad experience in the emergency room.

    You also assume that just because this man took an oath to be a doctor that he has forsaken his rights as a private citizen, one right which is freedom of speech. Unless Dr. Jones ignored this patient to write this article, I highly doubt he failed to live up to his oath as a doctor.

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  28. To the Anonymous that wrote: "In fact, fixing a tooth properly with a porcelain cap costs more than some tacky gold garbage. I don't see how this guy is abusing the system. To me he looks like he's ignorant and barely capable of wiping his ass, much less purchasing and maintaining health insurance. He is exactly the type of person who needs our help, and we only have ourselves to blame."

    I don't blame myself for being driven, wanting to better myself with higher education and maintaining a job so I have the means to take care of myself and not be a burden on society. I blame people like you who want to enable people to be this burden. Wellfare wasn't designed to be a career. There is no shame being on wellfare anymore. Food stamps come on Visa cards so there is no embarrassment. People should have to provide community service before collecting government subsidies (clean up parks, paint over graffiti). I require a drug test in order to continue employment. So should people collecting wellfare.

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  29. I never made the assumption that Dr. Jones is a racist, but I did take issue with his description of the young woman.

    Yes, he is a private citizen, but in my letter I was writing as one physician communicating with another. And I do not believe that it is appropriate for a physician to express indignation and outrage over a patient's payer status or lifestyle choices.

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  30. As someone who has worked in health plan management, I have a few things to say that might help clarify some issues here.

    1. Health care is very expensive, as are individual health plans. An individual with any health risks (such as a smoker) will have to pay at least $500/ month and possibly more. To give a sense of scale, remember that working full time at WallMart pays about $1200/month.

    2. If a person does not have prior insurance, he or she may be denied -- so the patient that Dr. Jones saw might not be able to buy insurance even if she wanted to do so, at any price.

    3. It is very easy to lose health insurance if you fall behind in payments. It is very easy to fall behind in payments when you are poor.

    4. Tattoos are permanent, so the presence of a tattoo does not give any indication of the person's current finances. The shoes could be fakes, the tooth is cheaper than a porcelain veneer, and the phone could belong to someone else. Ringtones cost 99 cents. Appearances can be deceiving. Yes, this woman might be making terrible financial choices, but that flashy exterior could be masking genuine poverty. I would bet that if you visited her home, you would revise some of your assumptions.

    5. The fact that she puts the emphasis on her appearance might mean that she is hoping somehow to rise above her situation, and does not have the education or social background to know that these things are not going to help her move forward.

    6. It is cheaper for us as a society to pay for her primary care than to only allow her to use the ER only in an emergency. Getting her into an HMO setting where they might be able to counsel her on fitness and smoking cessation and manage her overall healthcare would be ideal.


    7. I know that there are a lot of people who hate the idea of subsidizing her bad choices, but if you are a part of the same society (and like it or not, you most certainly are) you are going to have to address the issue. You can ignore her only at your own peril: are you going to let her die in the street if she doesn't take care of herself? Yes there are countires that do that. But then you still have the issue of her rotting carcass and the civil unrest that follows from that kind of desperation. The cheapest option, happily enough, is also the most civilized: pay for her health care, including the office visits.

    8. How can it be cheaper to pay her health care? Preventative care is cheaper than emergency care. Always. That's why HMOs are so financially viable and have taken over the market. Back in 1990 the big five insurers were all traditional insurance plans like Cigna and Prudential. By 2000 the top five were all HMOs like Kaiser. Even the holdouts -- the unions, the state health plans, the big companies -- now have managed care. You would be hard-pressed to find a large employer who even offers a traditional health insurance plan anymore. Get this woman into a managed health care plan and her overall health costs will go down.

    So, Dr. Jones, you might not feel you have much in common with this woman but she is a human being in need of treatment, and not simply a burden on your resources.

    All the best,

    Rabbi Kari

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    1. Rabbi, I agree that these people should be in a more preventative care track, but my experience as an ER RN, has a different story. I repeatedly see people Dr. Jones describes for VERY MINOR problems such that could have been evaluated at a clinic. I frequently see people making up complaints to get a pregnancy test done so they can get on welfare. The problem is that Emergency Room across the nation are used as "inconvenience" rooms. These people either don't want the inconvenience of setting up an appointment, or waiting at a clinic for there care. ER care is VERY expensive. More so than going to a Primary care, or clinic, but these people know that there is no co pay for them and they don't care if the billed gets paid because Americans are great at "bail outs." Thus the cycle continues.

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  31. I work in the ER as an insurance rep and it kills me every time I see this. Unfortunately this is the climate of today. We have people abusing the emergency room system for simple things like an earache, toothache, or what have you. But it's really hard to see people who are in legitimate distress having to be treated in a hallway because there are no rooms for them. Some rooms are full with people like the patient Dr. Jones described. I'll never forget the woman I had that when I asked her for her photo ID and insurance information, she replied, "Honey I got medicaid for me and all of my children (5 of them) I ain't paying for this." Then she pulled out a wallet that was strictly for her and her children's medicaid cards.

    Your sympathy goes out the window very quickly when situations like this happen. Or when you see the same patient everyday for multiple days to the point that you know their name, DOB, SSN and that all they want is a lunch box and someone to talk to.

    There's something wrong and I'm not exactly sure what's going to fix it.

    But kudos to Dr. Jones for actually saying his opinion.

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  32. Dr. Jones letter is written as a tax payer, not a doctor. The fact that he had this experience as a doctor is irrelevant as he never once mentions the medecine or the care provided tp the patient. If this exact same letter wad written by the person working at the regestration desk, not the physician, you wouldnt care, but both the physician and the registrar are equally citizens. If someone has the ability to provide for themselves and chooses not to is not a good reason for the government to provide for them. That applies to healthcare and all other government assistance, who cares if it is a healthcare provider making the statement or not?

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  33. All I have to say is this one made me laugh.

    "The point is that as physicians we should be held to a higher standard. There is no place in medicine for the judgmental views expressed in Dr. Jones's letter."

    I have worked with so many physicians for the last 10 years as a occupational therapist. Doctors have the least amount of respect for anyone in the medical field. A good portion of them yell at nurses and act like children and expect to be catered to at all times. Mostly this is the male MDs acting like pricks to the females in healthcare. Most are very booksmart but lack bedside manner and are just socially inept. So I have to laugh when they talk about holding doctors to a higher level when they act like spoiled brats and treat others in the field with little respect on a regular basis.

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  34. Dr. Craig Siegel is right. Dr. Jones is wrong.

    No where in the medical community allows judgments being past. None. It is NOT in their job description.

    If Dr. Jones wants to exercise his first amendment right, he can do so without the title of a MD.

    The title of MD is for medical treatments, not passing judgments. That's for judges.

    Ill use of the title means a lack of understanding of Mr. Jones' role in this society.

    It is not about pay, education, race, culture or taste. It is about using the wrong title for the wrong reason.

    And this backlash of responses is exactly the reason why the title of MD is disgraced by Mr. Jones.

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  35. Only a couple of things to say here, though I never claimed to be short on words:

    (1) I'm not a Bible-thumper by any means, but I do find the following passage somewhat instructive with regard to this issue:

    "...keep away from every brother who is idle and does not live according to the teaching you received from us. For you yourselves know how you ought to follow our example. We were not idle when we were with you, nor did we eat anyone's food without paying for it. On the contrary, we worked night and day, laboring and toiling so that we would not be a burden to any of you. We did this, not because we do not have the right to such help, but in order to make ourselves a model for you to follow. For even when we were with you, we gave you this rule: "If a man will not work, he shall not eat." (2 Thessalonians 3:6-10)

    (2) I will probably draw all sorts of hellfire for the remark I'm about to make, but I've always had more balls than my neighbors in terms of speaking my mind. You know what? We DO have an overpopulation problem. Plain and simple. Dare I say we're probably not terribly far away from the proverbial Malthusian dilemma.

    Though it will never in a million years be "politically correct" to say (and if you are offended by politically incorrect statements, please simply stop reading here and move on to the next poster's comment), when it comes to unwanted animals (typically shelter animals), we deal with the issue of overpopulation and lack of resources by employing euthanasia. Yes, thousands of unwanted animals undergo euthanasia every day for no other reason than the fact that there's nobody who can/will/wants to provide for that furry soul (by the way, this is not intended to be interpreted as "grandstanding"). Their only crime is having been born. Though all my fellow physician brethren will undoubtedly agree that human beings are simply a "higher-functioning" (??) taxon of animal life, in no way do we see fit to deal with our overpopulation issue in the same manner we have deemed necessary with respect to those other companion animals over whom we were ultimately given dominion.

    I'm not suggesting that we should resort to any forms of ethnicide or genocide or anything even remotely similar... I'm simply pointing out the subtle nuances in difference between our attitudes toward one form of life over another.

    Taking that to its logical (again, "??") conclusion, if we are willing to "manage the population" of other species by destroying them en masse for no reason of criminal behavior or retributive rationale, why are we not so quick to place some binding restrictions and terms on the people who will benefit from a publicly funded healthcare system that will be there to serve a human being who, by rights, should know better. If I walked into a grocery store and left without paying for a loaf of bread, they term that "theft." I understand that retail grocery and medicine are different fields of endeavor by nature, but only the dreamer physician can practice without an iota of regard for the disparity between these economic entities.

    Despite our evolution, humans have instincts. Deep down, we know what is constructive and what is destructive. That which differentiates us from "lower" (wow, ??) species is the capability of rational thought, judgment, and coherent communication. We can't expect dogs and cats to know that they should "keep it in their pants" (they don't wear pants). There truly is a culture of irresponsibility afoot that does threaten the very way of life as we know it, and this coming from someone who despises fearmongering. It's just rational thought -- something one would reasonably expect from one of my species.

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  36. Dr. S:

    Your spine appears to be missing. Did your wife take it to the dry cleaners along with an expensive suit? Or is it just made of wet noodles?

    Overtaxed American

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  37. His spine is more apparent than yours. It's easy to throw insults around when you are not willing to sign your own name to it. Not only does it discredit you, but it further illustrates my husband's point. The world truly needs more compassionate, nonjudgemental souls such as yourself. Yes, what a wonderful world this would be!

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  38. I love what you posted. So the lady had tatoos maybe her brother is a tatoo artist. So she has a cell phone maybe she works for ATT, working poor can still have medicaid in certain states. Cant forgive the smoking but I think as a cardiologist you will agree that it is very much a poor mans vice.. My point is how and why is a Dr judging his patients lifestyle and insurance when treating her.
    I agree completely that his letter has racial undertones. One does not need to have a masters degree to see the implied racism mentioning gold teeth and R/B. Of course whites can have these things but we do not live in a society so naive to not see the racial undertones.
    I can only hope that when my disabled child who is on Medicaid has to seek care that it is a Dr like you and not Mr. Jones who is seeing her for the human being that she is and not the white and blue KY card that she must carry.

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  39. This obviously bears repeating:

    Ravkari said...
    As someone who has worked in health plan management, I have a few things to say that might help clarify some issues here.

    1. Health care is very expensive, as are individual health plans. An individual with any health risks (such as a smoker) will have to pay at least $500/ month and possibly more. To give a sense of scale, remember that working full time at WallMart pays about $1200/month.

    2. If a person does not have prior insurance, he or she may be denied -- so the patient that Dr. Jones saw might not be able to buy insurance even if she wanted to do so, at any price.

    3. It is very easy to lose health insurance if you fall behind in payments. It is very easy to fall behind in payments when you are poor.

    4. Tattoos are permanent, so the presence of a tattoo does not give any indication of the person's current finances. The shoes could be fakes, the tooth is cheaper than a porcelain veneer, and the phone could belong to someone else. Ringtones cost 99 cents. Appearances can be deceiving. Yes, this woman might be making terrible financial choices, but that flashy exterior could be masking genuine poverty. I would bet that if you visited her home, you would revise some of your assumptions.

    5. The fact that she puts the emphasis on her appearance might mean that she is hoping somehow to rise above her situation, and does not have the education or social background to know that these things are not going to help her move forward.

    6. It is cheaper for us as a society to pay for her primary care than to only allow her to use the ER only in an emergency. Getting her into an HMO setting where they might be able to counsel her on fitness and smoking cessation and manage her overall healthcare would be ideal.


    7. I know that there are a lot of people who hate the idea of subsidizing her bad choices, but if you are a part of the same society (and like it or not, you most certainly are) you are going to have to address the issue. You can ignore her only at your own peril: are you going to let her die in the street if she doesn't take care of herself? Yes there are countires that do that. But then you still have the issue of her rotting carcass and the civil unrest that follows from that kind of desperation. The cheapest option, happily enough, is also the most civilized: pay for her health care, including the office visits.

    8. How can it be cheaper to pay her health care? Preventative care is cheaper than emergency care. Always. That's why HMOs are so financially viable and have taken over the market. Back in 1990 the big five insurers were all traditional insurance plans like Cigna and Prudential. By 2000 the top five were all HMOs like Kaiser. Even the holdouts -- the unions, the state health plans, the big companies -- now have managed care. You would be hard-pressed to find a large employer who even offers a traditional health insurance plan anymore. Get this woman into a managed health care plan and her overall health costs will go down.

    So, Dr. Jones, you might not feel you have much in common with this woman but she is a human being in need of treatment, and not simply a burden on your resources.

    All the best,

    Rabbi Kari

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  40. I work in a family practice clinic & I see what Dr. Jones sees everyday!!!! I'm not sure how anyone can say his letter is a bit racist. He never once mentions race. Where I live is predominantly caucasian yet his description could have fit any number of our pts of ALL races. Its about accountability. Yes there could be alot of "maybes" with this pt but in all actuality its rarely the case... I've been a clinic nurse for 10+ yrs & its only gettting worse with every passing year. As a nurse I try not to judge my pts, but I am a single mom of 3 taxpayer who has held a job since age 13. I use to drive home everyday after work to see a single mom of 5 up the road outside w/her kids because she choose not to work & the government was giving her every program under the sun because moms like me DO go to work & pay taxes to provide that to her. She was making $$ sitting on her rear at every taxpayers expense!! So no, I don't feel compelled to give these types of people FREE healthcare while the rest of us bust tail day in & day out. Thats my say as a TAXPAYING CITIZEN OF THE USA. As a nurse I'll care for any pt who comes thru the clinic door regardless & give them the best care possible but it doesn't mean we all have to be silent to the system abuse that we see daily!!!

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  41. I didn't take Dr. Jones' letter as racist. I have seen whites, blacks, and Hispanics who meet the description. For those who immediately assume he was describing a black woman, you should examine your own stereotypes to have perceived it as such.

    Nowhere in Dr. Jones' letter did he state or remotely imply that he provided less care as a result of his observations. His observations and subsequent assumption that this person should do a better job of taking care of herself and managing her finances were spot on.

    It's ridiculous when people say you shouldn't judge. Everyone judges - it's how our minds work. We take in information, process it, and make judgments and decisions. The goal shouldn't be to not judge - it should be to judge wisely.

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  42. To me the worst thing about Dr. Jones' letter is that it is now being portrayed as having been written to the President, which is completely incorrect. It just shows some people will stop at nothing, even misrepresenting a young doctor like Jones, to forward their anti-Obama agenda. Don't they realize that true consensus on health care reform will never take place as long as lies and misinformation continue to be forwarded?

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  43. I love that argument, it is your choice, I shouldnt have to pay for your mistakes. Say Dr Jones was a fire fighter and the patient was passed out-drunk at home then her cigarette set the house on fire. Is everyone complaining that her it was her mistake and we shouldnt foot the bill to save her?? Is the fire-fighter complaining to the White House that tax payers money is being wasted on people who pass out and burn their house down??

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  44. Give to the one who asks you, and do not turn away from the one who wants to borrow from you - Matthew 5:42 ... though I have to admit, Matthew 5:43 does say unless they are wasting their money on beer and cigarettes.

    Assuming most on here would say they are Christians, they are doing a fabulous job!

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  45. A society that knows no accountability eventually falls into chaos and anarchy. I'm in full agreement with Dr. Jones' letter, and Dr. Siegel, I do disagree with your racist observation, because to me it is a Cultural Issue and destructive cultural traits pervade all cultures be it the "white culture", the "black culture", or the "Hispanic culture". Unfortunately, this destructiveness is more apparent in some. I've had the chance to work with a lot of minorities and I've seen tragedies and triumphs along the way. In each instance it wasn't the government saving these people, it was other people who mentored to them and taught them an accountable life style. Too often in this country, we just throw money hand over fist at the problem, but we don't invest ourselves into the problem.
    Someone may come into the emergency room or into your own practice and need help. Basically you patch them up and send them back into the war zone... What are you doing to change the behavior, to change the habit, to create a new insight to pull from? You're not..

    Remember the saying, "Give a man a fish and he'll eat for a day. Teach a man to fish and he'll eat for a lifetime." If that isn't the greatest message for teaching accountability then I don't know what is. Eventually you have to draw a line in the sand and say no more. It's like training a child. When a child does something wrong or unsafe, you teach that child the right way to do it, which is the same way of saying the right way to live.

    I've had to work my entire life for everything I have and I come from a single parent family, but I knew love and came from an upbringing that taught accountability and not just to wait for another handout. It isn't morally right that I should have to continue to pay for another's lack of accountability. If that person wants a hand up then I'm more than happy to help and it's why I'm involved with many United Way programs, but if the person does nothing to help themselves, then I say leave them to their over devices. In the end, the decision lies with them.

    I can say in all honesty that I would happily pay more taxes if I knew the people receiving my hard earned money were doing something to better themselves. However, our government wants to create a system with even less accountability than what we have and I do believe it will lead to a collapse of our system.

    I could write a lot more, but what's the use? I do my best each day of my life to live my best and help others. I do feel like I'm a slave of our government, but, the alternative of going somewhere else could be worse. So, I'm stuck with what we got. I just try to make the best of it.

    Dr. Siegel, I admire your willingness to offer your perspective on all of this, and in a perfect world, it might be alright. However, this is not a perfect world, and I do think your perspective is insulated from reality in many ways as from what I've read in your profile, I don't know if you've actually experienced what many of us normal Americans have had to deal with. I grew up in an area of the country where this stuff is prevalent each and every day. However, I was blessed with a good family upbringing and the desire to do something with my life. Obviously, you're highly intelligent and I can relate to Organic Chemistry and many of those courses since I'm a chemical engineer, but I would just ask that you think about the other shoes that people from different walks of life have to walk in each day and what they're saying.

    I'm convinced our country needs a Cultural Revolution, and it's not just for some, but all of us.

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  46. seems to me the patient got treated even without healthcare reform. Since we are already giving heath care to these "types" patients, reform will be used for assuring those with pre existing conditions or expensive care medicines get healthcare.
    @mary and @trish. Your logic and compassion will always be drowned out on blogs such as this one. Blogs filled with individual that do their research on hate radio or their facebook page.

    PS Dr Jones' letter is either fake (most probable), embellished, or not written by not currently employed doctor. And, yes it was intended to fuel the racist flames. This country needs more critical thinkers (the ability to research a source, not to overgeneralize one individuals opinion, etc.)

    sorry to use anonymous, but 'source' doesn't mean much to you folks anyway.

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  47. ROGER STARNER JONES, MD
    The things he postes make me scared to get any treatment, I am a smoker, so now I see that if I go to the Doctor, they will be posting about me. SICK!!!!!!!!!!!! Don't drive on the roads DR. The taxes on Cigs are higher than you could ever pay!

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  48. I have a paradox for the blogger since he repeatedly states that physicians should never pass judgement or offer opinions on major social policies being legislated on. Apparently Mr. Obama feels very different than you do and his actions prove this. Why else would he parade out, like trained poodles, a whole phalanx of physicians dressed in their white coats to surround him while he gives a speech on passing his healthcare plan? Why did he care so much about the AMA endorsement to the point of literally bribing them with promises of passing a permanent Medicare funding bill in order to get it? And why then instruct those physicians and the AMA itself to PASS JUDGEMENT on the legislators and the majority of American people who were against the bill and paint them as the worst human beings in the world for speaking out against the legislation? I think you need to either accept physicians who speak out and offer opinions that differ from your own (like Dr. Jones), or did the AMA and these physicians who spoke out in favor of the health care legislation ALSO do your profession a disservice?

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  49. Dr. Craig... I am a member of Americans for Healthcare. You correctly identified the poor judgment of Dr. Jones. He subtly implied that this person is a "medicaid" cheat who costs taxpayers money because of his lack of responsibility. He also has a racist tone since most people identify people on Medicaid as poor and black.
    The health care crisis is not due to poor people. It creates poor people who go bankrupt, die due to a lack of early care, and who land up seeing these second rate judgmental doctors who should have gone into another professional.
    It is suspciious that that letter has gone viral on the internet and bolsters the view that at the core of crisis is the poor and uneducated who have a poor life style.
    Many rich people who don't pay their fair share of taxes, whose taxes the GOP want to lower their taxes, and who among the icons of our society cost us money.
    Only when we get affordable, universal health care that stresses prevention and good life styles will we reach our goal.
    This doctor's medical education (as poor as it was) afforded him a good salary and was in whole or in part paid for by our tax dollars.

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  50. Dr Siegel,

    Curious, I wonder if you volunteer your time to the free clinics around you to help alleviate the lack of access to health care? The ED is bascially a free clinic. I am sure your payor mix is not like ours. I am tired of hearing other physicians not seeing patients with medicaid or similar government funded insurance not seeing these pateints we see in the ED in follow-up. The typical response is, oh I am sorry, I don't take their insurance. They will have to see someone who does. Or it is a $50 co-pay to be seen, which they can't. All of Dr Jones's colleauges see every patient that walks thru the door, no matter what insurance they have or who they are. I am sure that is not the same for your cardiology colleauges. I am curious to know if your office sees patients without collecting a co-pay up front and not a bill me later scenario.

    ED physician

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  51. Diane S Corapeake NCSeptember 16, 2010 at 9:18 AM

    I myself see both sides. Having worked in the medical field I have seen the abuse of a service that was meant to help people out, not in. As we tell our children, come to us for help when you have pawned all of the unnecessary things you have in your life and aren't coming to us with a drink in your hand and a cigarette dangling from your mouth. we should go old school and not help anyone until all other avenues are closed to them(their families,churche, ect....My mother raised 6 kids on her own with no help from society(oh and so you don't jump to any conclusions, I am white!!

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  52. I see both uninsured and Medicaid patients in my office on a regular basis. No one is turned away because of a lack of coverage. Furthermore, I am on call on average every third night for one or more of our local emergency rooms and am expected to respond promptly regardless of the patient's payor status. Those patients later return to my office for follow up and establish long term relationships with me.

    Let me be clear on another point. Dr. Jones and his letter are most definitely real. And while he may well be frustrated with our health care system, as a physician he has no business passing judgment on the patients under his care. The content and tone of his letter are offensive.

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  53. Dr. Siegel,

    Unfortunately I, along with many, many Americans, feel that it is your views that are fundamentally flawed, as well as incorrect. Dr. Jones isn't saying anything that most taxpaying Americans don't believe. I have personally seen many individuals who choose to live solely on government assistance because it's "free". They don't work, they neglect their responsibilities and they raise their children to have the same attitudes and lack of any personal ethics or morals. If they choose $200/mo cable TV, expensive cell phones and take out food every night, then they have made their choice. Taxpayers shouldn't have to pick up more of their bills because they now need "healthcare coverage" too. Dr. Jones doesn't once say that this person whom he writes about, should be denied basic care or should be left to die on the street. He does question his responsibility to be financially liable for their lifestyle and health choices. He absolutely has that right as a taxpayer and an American citizen.

    We, as taxpayers, should not be responsible for footing more bills for individuals that choose that lifestyle than we already do. This nation of ours has created an entire class of individuals (of various colors) who will live their whole lives on the taxpayer dime and their only contribution to society will be to produce more individuals just like them. That's the truth. Period. Yes, there are people who will rise out of that lifestyle and strive to become productive members of society, but they are not the rule, they are the exception. And sadly the truth is that all of the enablement that we as Americans fund, really does significantly more to keep them down, rather than provide any opportunity for them to rise above that lifestyle. Your attitude that Dr. Jones shouldn't judge his patient is part of the problem; if everyone chooses to ignore truths because they might offend someone, then how will we ever fix the real problems?

    The bottom line is, sir, that if you don't want to be judged or be beholden to someone, you cannot live in their pocket.

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  54. It is so easy to judge other people's choices and not our own. I pay for insurance that I rarely use. I eat organic and exersize and hour a day 5 days a week. I am doing everything I can to stay healthy and insurance is there incase I get hit by a car while biking or get cancer. The money I pay into insurance pays for people who never exersize, who eat processed/chemical laden food (did you know that fruit consumption has declined since 2000 and that vegetable consumption has remained flat?) All of those people who are lucky to have insurance are using the money I pay into insurance to fund their excessive lifestyles full of poor choices. But Dr. Jones doesn't pass judgement on them, just on the poor. It is easy to judge others and easier to not look at ourselves. Just because you can pay for the right to be unhealthy doesn't make you better than anyone else. I am happy that I do not live where Dr. Jones practices because he seems too busy to step outside of himself (although not to busy to point out how he is so much better than others) and actually practice compassion.

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  55. Physicians are not anthropologists. Apparently many of you aren't much interested in science, you just have these feelings that you feel, and want to share. Aw, that's sweet. It's also annoying. All you tough bootstrap monkeys pontificating about how people should just do this or that, without a hint or clue how they live. No study, just your feelings? The hell with your stupid feelings. I don't like you because you expect me to care about your feelings - so, I don't. Bring me science, or keel, kick, and die.

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  56. I First Saw the E.R Doctors post thru facebook and let me tell you it is a shame for me to see someone driving a new car, with new clothes fancy jewlery waiting in a line for medical card or a check from the state or even worse food stamps that so many others desperatly need, I am a 27 year old survivor of poverty and abuse I have lived more in my lifetime then ten men do in theres, I buried my brother 6 years ago cause he was not strong enough to fight and get help I still struggle everyday with the fact that I have an addict of a mother and a father that looked at me as a wife instead of his daughter, I have a 7th grade education and don't for a second think that I have not tried to better myself, but 5 years ago I was diagnosed with having type 2 diabetes so I put my mental health on hold to try to get my body healthy, Now first of all let me say Dr Siegel I have been turned away cause I owed a small bill we are talking under 100 dollars so I am forced to use the ER as my primary care, Now apparently he has seen the same things I have!!! people like me who desperatly need the MEDICAID and can't get help and then to see someone who apperes to have everything, be handed even more. I'm sorry you took offense to his letter but I thank him for his voice maybe we need more Dr. to speak up and it has nothing to do with race sir. so please pay attention to what I have to say, I have teeth falling out and half the time can't afford to pay the phone bill and have rocked the same pair of $20.00 walmart shoes for 2 years Oh and did I mention that there have been many nights Rob and I have to resort to eating eggs and toast for dinner so that we may keep what little bit of food we have for are 4 year old daughter. did i mention that I am $40,000.00 in medical dept, and yet I have to fight to get assistance and will in all realty never win.

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  57. I find it hard to believe that most people don't see this as being extremely racially charged. No, it's not EXPLICITLY written as such, but my first thought at seeing this was: "Black people and their hip hop music is what is REALLY wrong with this country."

    While it most likely is true that waste, fraud, and abuse exists in countless government programs, it is foolish to become outraged over one anecdotal letter.

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  58. Krystal, may I draw your attention to the last two sentences in Dr. Jones letter: "Life is really not that hard. Most of us reap what we sow." I am astonished that this is a man whose views you choose to defend?

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  59. Trish, Right life should not be that hard with the right kind of help!! and the second part of that quote says MOST, My path was chosen for me when I was born I never asked for the things when I was a child, but I have asked for help NOW and have been denied unlike that person in his letter, and I for one have worked since I was 13 and paid taxes and into Medicaid and now I need help, when will I recieve it when my leg is cut off or i'm on Kidney Dialisis witch is what the docs are saying will happen in the next 10 years if I dont get the proper care, I did not ask are goverment for pity I asked for help!!!

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    Replies
    1. Krystal, your plight is very familiar to me. I have aquaintances who fell on bad times and needed ASSISTANCE. Because, they were still working and had some income they were denied ASSISTANCE. The biggest problem with entitlement programs are that they are not in place to assist, but replace. My friend has said since the Obama administration has taken over, her food allowance has gone up so considerably she can't even use it all. What is that? Is no one in this office capable of accounting? Why can't people with lower incomes get assistance while still making an effort to work? What is with this all or nothing attitude about a service that was invented to help people? Krystal I'm sorry for your situation if anything you seem to be someone who could use the system, but because there are so many abusers in the system, there is no help for you, this is what the tax payers are outraged about! The slackers that sit at home pushing out child after child to stay on a system that rewards them for it. This is the "culture" Dr. Jones is referring to. When will these people be held accountable for their decisions?

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  60. I completely agree with Dr. Siegel, this doctor's job is to help people, he is to diagnose and treat.

    You never know the reason she is in her situation. The high rate of unemployment has increased the number of uninsured individuals.
    Judging her based solely on appearance is wrong. When you lose your job and insurance there is no magic genie that appears and takes away your possessions the day you become employed and what exactly did he think would happen to her tattoos?? Were they supposed to disappear, too?? I would not want him as my doctor. I like Rabbi Kari's response above.

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  61. Since this was too long, I guess I have to post in sections. Part I is below.

    Dear Dr. Siegel:

    Thank you so much for posting your civil reply to Dr. Jones' letter to the editor. We need more doctors like you - those who went into the field not to make tons of money, but who genuinely want to serve humanity.

    I have several points to make - and agreements with some.

    There are many physicians who live unhealthy lifestyles. Dr. Gourmet (aka Dr. Tim Harlan of NO) even sometimes posts photos of donuts etc. I can only imagine with their insane schedules that interns and residents have even more unhealthy behaviors - including the lack of sleep. If unhealthy behavior, therefore, were a disqualifier for receiving health insurance, therefore many of the physicians themselves would have none.

    Yes, the letter was written with racist overtones - and anyone who argues otherwise is either lying (perhaps to him/herself) or oblivious! There was no C&W / rock ringtone, no brand-spanking new cowboy boots or hat (which cost fortunes, too!) etc. mentioned in the letter. Dr. Jones' letter was meant to appeal to the racists in this country who don't get angry at the majority WHITE individuals who comprise the welfare rolls. It's oh too easy to get angry at "the other," but easy to excuse "the same."

    Let's assume that the individual affords the choices via selling drugs. Well, who buys those drugs? (And what about the people using them? Apparently, we should deny them insurance, too.) If there were no market, there would be no sellers! Oh, and big news flash: who controls drug markets, anyway? There are "executives" in that business just like any other...

    Although I can't locate the verse right now, doesn't the Bible quote Jesus as saying something about letting those without sin cast the first stone? (I have to admit that I, too, can get more righteous than thou - but am oftentimes get brought down to earth real quick.)

    Anyway, I personally am more pissed off about the government (i.e., "we the people") spending monies on wars. I always think it's quite amusing that people get all up in arms (no pun intended!) when we talk about, oh, 4% of the federal budget as opposed to up to 40% (depending on what interpretation of the budget one uses). The US spends 40% of the entire GLOBAL expenditure for weapons: six times the expenditure of China. Oh, and civilian deaths just in Iraq: as "little" as 100,000! Anyway, my point is that I'd rather get all het up about BIG expenditures (and in more than money!) than small ones.

    And overpopulation, puh-lease! We are one of the least populated nations, but we (and Europe, also least populated) use 80% or so of the earth's resources... Anyway, the person who made those remarks sounds remarkably like a historical figure who also had good "reasons" for eliminating whole populations of individuals! Should we also simply euthanize Americans who have birth defects of some kind of another versus just use race or intelligence as a criteria. (Actually, come to think of it, Americans are some of the least intelligent individuals on the planet. Perhaps this gung-ho proponent of euthanization is in favor of gassing or even nuking entire states, especially those who don't score really low on "No Child Left Behind" exams.)

    I really like the comments of those who rationally show the cost of a "gold" tooth over the cost of health care. Bravo.

    To those of you who work hard and don't go on welfare: good for you! (Which, by the way is somewhat of a misnomer. Remember the "flaming liberal" Clinton - who took a Republican "Welfare to Work" concept and mandated some sort of work component in order to continue to receive benefits?) You can feel superior to others - and probably get a big, fat mansion in heaven, besides.

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  62. Part II of my response. (Sorry if there's repetition, but it didn't post and I don't remember where I left off.)

    Let's assume that the individual affords the choices via selling drugs. Well, who buys those drugs? (And what about the people using them? Apparently, we should deny them insurance, too.) If there were no market, there would be no sellers! Oh, and big news flash: who controls drug markets, anyway? There are "executives" in that business just like any other...

    Although I can't locate the verse right now, doesn't the Bible quote Jesus as saying something about letting those without sin cast the first stone? (I have to admit that I, too, can get more righteous than thou - but am oftentimes get brought down to earth real quick.)

    Anyway, I personally am more pissed off about the government (i.e., "we the people") spending monies on wars. I always think it's quite amusing that people get all up in arms (no pun intended!) when we talk about, oh, 4% of the federal budget as opposed to up to 40% (depending on what interpretation of the budget one uses). The US spends 40% of the entire GLOBAL expenditure for weapons: six times the expenditure of China. Oh, and civilian deaths just in Iraq: as "little" as 100,000! Anyway, my point is that I'd rather get all het up about BIG expenditures (and in more than money!) than small ones.

    And overpopulation, puh-lease! We are one of the least populated nations, but we (and Europe, also least populated) use 80% or so of the earth's resources... Anyway, the person who made those remarks sounds remarkably like a historical figure who also had good "reasons" for eliminating whole populations of individuals! Should we also simply euthanize Americans who have birth defects of some kind of another versus just use race or intelligence as a criteria. (Actually, come to think of it, Americans are some of the least intelligent individuals on the planet. Perhaps this gung-ho proponent of euthanization is in favor of gassing or even nuking entire states, especially those who don't score really low on "No Child Left Behind" exams.)

    I really like the comments of those who rationally show the cost of a "gold" tooth over the cost of health care. Bravo.

    To those of you who work hard and don't go on welfare: good for you! (Which, by the way is somewhat of a misnomer. Remember the "flaming liberal" Clinton - who took a Republican "Welfare to Work" concept and mandated some sort of work component in order to continue to receive benefits?) You can feel superior to others - and probably get a big, fat mansion in heaven, besides.

    Guess what? My mom was on welfare when I was a kid. She's completely disabled and is on SSI now. She smokes and has a heart condition, too! (Oh, Mr. Euthanizer, shouldn't we have gotten rid of this one a long time ago? My spouse may agree with you.) I myself was on disability - but am now a card-carrying, tax paying, red-blooded citizen. (Oh, but I'm "morbidly obese" according to insurance tables. Apparently, I should be heading to the ovens! Especially since I'm in law school, right?)

    Oh, and, by the way, despite all the health insurance we are blessed with, the docs seemed to miss a heart condition in our national-qualifying athlete - which resulted in that child's death. (Our other child is also "morbidly obese" and is an English major. Horrors!)

    Anyway, I'd go on, but think a book would be more in order!

    Thanks, again, Dr. Siegel!

    Sincerely,
    C. Brown

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  63. I would tend to agree with the good Dr. Jones. It is horribly upsetting to know that individuals who subsist on welfare and medicaid utilize the resources that they have to purchase tobacco, alcohol, tattoos, etc.
    It is disturbing to drive through a HUD housing complex and witness that the vehicles in the parking lots are brand new Cadillac Escalades and the like.

    Health Care Reform is necessary to make affordable health insurance accessible to everyone. But who determines with "affordable" actually is? If the government requires citizens to purchase health insurance or be taxed, they better be prepared to offer budget assistance to a lot of families, not just those on welfare.

    I dont think that the issue with health care or subsidy is a "Culture" crisis so much as a "Social Welfare Crisis". Restrictions and accountability should be required for any person to receive Federal Aid.
    Make those who receive food stamps take cooking classes.
    Those who receive money take budget classes.
    Those who receive medical take a class from a health organization on managing their care.

    Educate the masses. Hold them accountable, make receipt of Aid dependent on following RULES, and make Government ENFORCE the rules that are in existence.

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  64. Thank you, Dr. Siegel, for taking time from your very busy and productive life to post such a compassionate and generous response to an ugly provocation by Dr. Jones. I certainly know who I hope greets me when I need the services of a medical professional. I am a college professor with good health insurance who exercises regularly and does not smoke; I also am no more valuable as a human being or deserving of care than the woman Dr. Jones scorns. The fact that I have had advantages in life does not mean I am any more worthy of access to healthcare. We all deserve to be treated with dignity and respect regardless of our income or personal faults. Finally, there was no reason for Dr. Jones to have mentioned details such as the genre of the woman's ringtone other than to make subtle reference to racial cues any American could recognize; he left enough room to pretend that race never entered the discussion but such cynicism and disingenuousness is pretty transparent. Thank you again!

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  65. Dr Siegal, I think you, along with others who tried to paint pictures of racism and accusations of cheating, missed the point Dr. Jones was trying to make.

    The point was that may people today do not make wise decisions and/or spend money foolishly on luxuries while looking for handouts for necessities. Yes, I understand people are poor and sometimes have limited options, but it is ridiculous for those who choose to buy more toys/luxuries than those who decide to live within their means to rely on government assistance to put bread on the table. They should be required to re-prioritize rather then be enable. It's like the college kid who gets allowance for gas, food, ect and by mid week he's asking for gas money cause he had too much fun earlier in the week, and you wouldn't want him to run ought gas on way to school or starve would you??

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  66. I work full time and pay for my own medical insurance with no assistant from my employer. My annual income is around $27,000. I was stupid when I was young. I quit school and moved from my home very young. Even then I took my responsibilities very serious. I have worked since I was thirteen-years-old and have always paid any bill I have ever had. Of course, now that I am older I still pay for the mistakes I made when I was young, and do so gladly. But I am stuck in the middle of the middle and lower classes. I was denied medical care in that I was told I needed surgery, but at the time had no medical coverage. I qualified for no assistance of any kind. I was told I would have to pay 90% of the costs up front. Now that I have medical insurance it is still almost impossible to come up with the deductable and the uncovered twenty percent because almost no doctor in private practice will accept a payment plan. The hospital will but if not paid within just a few short months, the account is turned over to collections. I would almost rather stay sick than have collectors calling and harassing me. I don't understand why the laziest people can receive all the care they need, when they are obviously never going to pay the bill or the tax payers are going to have to pay the bill. There is not one person, doctor or agency who would lift one finger to help me and give one blue hoot whether I am a healthy American. I am actually so sick and tired of seeing people use and abuse the system! It is the same across the board, healthcare, welfare, SSI, food stamps, unemployment. I agree with so many people who think, if I have to pass a drug test to work, others should have to pass one to receive unemployment benefits. Although I believe a person should have to pass a drug test to receive any benefit that come from a government based or funded system. These people need to get off of their behinds and take some responsibility for themselves.

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  67. In finishing my statement: My mother is ACTUALLY disabled from a wreck that did take her life several times before a wonderful trauma team finally saved her. I have seen her be treated terribly by doctors. One doctor had the audacity to actually say that he needed to hurry up and release her from the hospital because she was "on medicaid". I have seen both sides. But, I don't see how anyone can say there are not people who are lazy, overweight, drug using alcoholics, and people who spend their money on many things besides insurance because they need their toys and bling out there taking advantage of system I help support with money I could use for my own healthcare. I am not saying that any American's healthcare should be limited or denied, I am just saying that is off kilter when the laziest people in this country can receive top-notch medical care and I cannot! People gripe about equality and yet the system is not about equality. The lazy people living off the system should be glad there is no equality, because the scales are tipped in their favor. I would be glad to be treated as their equal. I would love to stay home all day and keep my house as clean as I want, keep my yard as well-kept as I would like and maybe take up a couple of hobbies, all while collecting welfare, foodstamps, and medicare! I could handle that for a little while. But as long as I want to have a JOB, and take the responsibility of my JOB seriously, I will have to pay my own way.
    I am sorry, but I am of the opinion that a fair many doctors are not in their line of work because of the hippocratic oath, but because of the wonderful financial living it provides. That is fine with me, all doctors worked hard and earned the money, right and title. Lets just stop acting like all doctors should care so deeply about human-kind and not the almighty dollar. If this were the case, would there be more free clinics with actually doctors available. Wouldn't it become more common that somebody needed surgery and a team of doctors came together to provide free service(so common that it wouldn't be big news on CNN when it happens). I agree with Dr. Jones. I can't imagine how hard it would be to help somebody who is wearing enough to pay for the visit to the hospital and yet his taxes will help pay that bill.

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    Replies
    1. Free clinics = potential lawsuit. There are too many lawyers and lawsuit happy people out there to provide healthcare for free. A doctors biggest expense is malpractice insurance, and because of society being what it is today, with everyone trying to make easy money, the needy suffer. If we want to save healthcare and make it more affordable, why has no one in legislature proposed caps on lawsuits? Because most of your legislatures got to where they are today via LAW SCHOOL, and lawyering. I propose caps on lawsuits, assistance to people who are working, instead of sitting on their butts at home, and drug screens for assistance, for starters.

      Delete
  68. Stop attacking Dr. Jones.

    You people who say you detected a racial undertone: Its because you associate the OBSERVATIONS he made with certain minorities in your own heads, yet you want to think you above it all.

    If this patient can afford all the latest fashions/electronics/vices, this patient is obviously capable of earning/gaining wealth/money from somewhere.....but when it comes time to pay medical bills/healthcare they would prefer to take the free ride on MY back.

    Trust me, if there was a place this patient could get free additional tats, shoes, phones, etc.....you better believe they would be in line waiting for it.

    How can you not clearly see this is a CULTURE CRISIS......????

    I also blame this patients parents - I am sure they did the same thing. It's time to break the habits these people are raised to believe are okay.

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  69. Dear Dr. Craig Siegel,

    Sir, we are all entitled to our opinions, and I thank you for sharing yours. I’m sad to hear of your offense in regard to Dr. Jones’ “letter”. However, I agree w/ the many that have pointed out that this Dr. Roger Starner Jones said nothing re: race or that he, as a physician, didn't have an obligation to care for that particular individual mentioned. Just because one is wearing expensive tennis shoes, listening to hip-hop, & has a gold tooth doesn’t mean they are of a certain race! More and more cultures, white, black, Chinese, Hispanic, etc., are melting together while enjoying the same things including how they represent themselves. In fact, I wouldn't be surprised if the patient he mentions in his "letter" was a mere figment of his imagination created to simply make a point. There are many in our culture (not specific to ANY particular race) that fit into the very mold represented by Dr. Jones’ patient. After all, aren't we all entitled to our opinions? Shouldn’t that not only include yourself but also Dr. Jones as well as everyone else commenting on your blog? Not pointing figures, but as mentioned before, usually those first to cry racism are the biggest racists of all… All who read this, please consider that for a moment.

    Unfortunately, it seems there is a sense of arrogance or superiority in your responses on this blog entry re: Dr. Jones' letter. I don’t know you in any way, shape, or form, but from the way you’ve presented your opinion, it feels as if you’re on a soap box & standing firm. Again, you are certainly entitled to possess the opinion you have so easily shared. In fact, it is welcomed. In a previous comment, someone mentioned the difference between an ER physician and those in the field of cardiovascular medicine. I see in your bio that you are a cardiologist. You know, as well as I, that being an ER physician is a far cry from being in cardiovascular medicine on many counts. In light of being two very different physicians, please don’t think you and Dr. Jones are seeing Dr. Jones’ stance from the same perspective. Yes, I read that you’re “on call every third night for one or more” local emergency rooms. I’m not sure, but isn’t that at least part of the requirements of having privileges at a particular hospital? While recognizing your efforts as a cardiologist practicing medicine in an ER, I still see a difference between a cardiologist in the ER to see patients while they’re on call and an actual ER physician in the ER on a daily basis dealing with all patients not just those with or suspected of having cardiovascular troubles. I have a few friends that are physicians, and on more than one occasion, I’ve been informed that cardiologists are at the top of the food chain (due to the pay grade & responsibilities, including surgical duties, bestowed upon them), if you will, while ER physicians and internal medicine physicians are at the bottom.

    CONTINUED…

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  70. Part II

    We have a serious issue in our society that is not specific to one race. We, as Americans in general, are no longer hard-working, tax-paying, good citizens as a whole. More and more we are seeing those wanting something for nothing. Isn’t it easier that way? Why work for something if we can get it for free? Now, I say that not without compassion for those who truly are in need of assistance. As a society, I believe we have an obligation to assist those unable to assist themselves or are in need of compassion in light of their situations. However, I’m sure you’re aware of the many people in the welfare system that choose to not work and have no issue living off the charity of others. I personally know of many (those that have confided in me face to face) that brag of the fact they are getting things for free through government programs & don’t even have to work in order to get these free perks. That’s their life while I, as well as many others, work in order to live paycheck to paycheck so we’re able to pay the bills and take care of our families. It’s difficult for me to feel compassion for those who use the government programs, designed to assist those truly in need, for their “personal credit cards” giving them license to indulge themselves with little to no cost to them. That, my friend, is what I think Dr. Jones’ letter is referring to.

    My response here is in no way to be disrespectful to anyone sharing their opinions here or to speak without trying to see both sides of the issue. I think, before taking offense, we should deeply consider what’s being said and not take things at face value without first considering what is presented to us. Health care seems to be very controversial these days, but thise goes way beyond healthcare reform. The issue truly lies in our society & where we now find ourselves as a culture. Unfortunately, we find ourselves in a self-indulging, narcissistic, uncompassionate position with the bottom line being that we care only for ourselves. I close with commending you on your desire to be a compassionate physician & wish you well in your medical endeavors. I am an optimist at heart and hope, for the sake of all, that our society wakes up to the harms of the issue presented here…

    P.S. I find the name of your blog, “Swimming with a Piano on my Back”, quite clever. It made me smile.

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  71. I am a chronic pain patient who has also had decades long problems with depression. Speaking for my fellow pain patients I can honestly say that Roger Jones disdainful attitude towards patients is more common than attentive and compassionate care. It's one thing to face an "I got mine" attitude on the street; dealing with it from a physician is appalling. This idiot should have his license pulled for anything but coroners work.

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  72. A few more comments:

    1. We as a society have some of the best health care that money can buy. Unfortunately, it is held captive to a highly inefficient distribution system. There are other industrialized countries (most of Europe, for example) that spend less on health care (as a percentage of their Gross National Product) and have lower infant mortality rates and longer life spans. Our current system could use some serious reform.

    2. There will always be a subgroup in society of people who are unable to take care of themselves, whether it be from illness, mental illness, or poverty, and who have no one to turn to. In our country these folks often end up homeless if they are not institutionalized. You -- all you able-bodied out there -- may feel that it's unfair that you are burdened with these people, but I'm sure most of them would gladly trade places with you. You can argue that there are more out there who fall into this category than really should be there -- that's fair. But I think it's necessary to accept that even if you implement rigorous welfare reform and assign all kinds of checks and balances you'll still have a percentage who genuinely cannot care for themselves.

    3. That group -- whether you think that there are too many people in this category or not -- still needs healthcare. Our current system requires that they wait until it's an emergency to act. So, rather than take a beta blocker for hypertension or insulin for diabetes or use an inhaler for asthma, all of which require significant monthly payments on their part, they (whether they want to or not) wait until it's an emergency. So they show up in the ER unable to breathe, or nearly comatose, or unable to use their left side. Sometimes it turns out it's nothing, really; but ther are a lot of catastrophic cases that receive no treatment until it has become life-threatening. And then they run up an astronomical bill in the ICU.

    4. Some of the reasons why they have poor health habits are built into their situation: it's hard to exercise if you can't walk outside in your neighborhood after dark for fear of getting robbed or worse. It's hard to eat well when orange juice is a costly luxury. You can't be compliant with your prescription drugs if you can't afford to buy them. You can't cook heart-healthy meals if you are living on the street.

    5. Providing a full plan of coverage is cheaper (seriously cheaper) than just covering the ICU in an emergency. How on earth could it be cheaper to cover ALL of their doctors visits and ALL of their prescription drugs? Back to my diabetic example: even if all of the patient's diabetic care costs say $300/month to fight the disease, that's still MUCH cheaper than a week in the ICU, by an order of magnitude. Or to put it more simply: would you rather pay $4000 a year for five years or ($20,000) or $150,000 just once every five years. It's cheaper to cover the care from the get-go than to just pay for emergencies. You see what I am saying?

    6. If you'd like to reduce the number of people needing the state to support them, then start voting to invest more money in our public schools. Graduating from high school makes a major difference in a person's ability to be self-sustaining. I'd also suggest implementing a cafeteria program that is based on whole foods and good nutrition.

    Rabbi Kari

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  73. Without question our health care system is seriously flawed, which is why I support reform. And I am a strong believer in personal responsibility. But I also believe that as a physician I have a moral obligation not to pass judgment on the patients under my care.

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  74. I'm sorry, without proof that the phone was owned by the patient (version has a deal were you get a second blackberry free on your plan), if the clothing was purchased full price, or is not a knock off. The tattoos and life style weren't in place before the person came on hard times ( we are talking about Mississippi, Katrina country) and the gold tooth isn't a piece of colored aluminum. This doctor jumped to conclusions, violated Hippa law, and wrote a public letter containing privet information given to him by the patient during the course of care, for the purpose of care, not judgment. ( oh yes and a general description of the person Mississippi hospital area gold tooth drinks allot, smokes allot) He's so much more than a doctor he's a judge jury and executioner, oh I'm sure that person got substandard care. But I'm sure the bill to our government didn't reflect that with any discounts. So when can we expect the letter to the editor from the patients demanding the government get their moneys back.
    Or the law suit for the hippa violations.

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  75. Dr. Siegel, if you feel it is your duty and privilege, to serve the people that blatantly misuse our health care system for non emergent reasons, then might I suggest that you start a fund to pay for their health-care out of YOUR pocket. This kind of system abuse is wrong on all counts, and it is growing out of control.

    My husband and I have six children (by choice), he makes $60,000 a year, and I am a stay at home Mom. We PAY for our health care, as well as, our food and housing. IF we can do it, then so can others. We do not smoke, or drink, nor do we eat out, because WE CAN NOT AFFORD IT!!!!!

    I don't care what COLOR/RACE the person Dr. Jones is referring to, but this kind of behavior is completely wrong, and it is destroying our country.

    And for your information, I have seen this sick behavior with my own eyes, I was at one time a Paramedic (over 20 years ago), and would be summoned to a "patient's" house, only to arrive and be shown their "gold card" & told that they had a headache & wanted a ride to the hospital. So, my suggestion to you, Dr. Siegel, is to wake up & look outside of your little office and waiting room, because there is a whole lot of system abuse going on over in the ER....and guess what?! WE ARE ALL PAYING FOR IT!!!!

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  76. Dr. Siegel: I hear you loud and clear when you state above, "But I also believe...have a moral obligation not to pass judgment on the patients under my care" HOWEVER...

    You work in a specialty in which the CLEAR majority of patients have healthcare coverage or medicare; please don't deny this fact. It is easy for you to talk about the system being "seriously flawed" from your lofty suite, when Dr. Jones and all ED staff physicians are on the front lines of battle against system abusers, drug seekers, and other non-emergent "patients". You, sir, have no right at all to judge Jones or any other ED physician.

    Yesterday I watched a 2 year old child die on the pavement in front of my house after being hit by a car. Our county has TWELVE transporting ambulances during the day and TEN were on bullshit calls for people needing painkillers for their headaches and backpain; resulting in nearest available ambulance having an eleven-minute response time to get to that baby.

    Don't you dare sit on your lofty perch and tell me or anyone else on the front lines that the system is not being abused, or that we need to stop judging, or that we need healthcare reform. HEALTHCARE REFORM AS IT IS BEING PRESENTED WILL ABSOLUTELY INCREASE ALREADY-OVERLOADED EMERGENCY DEPARTMENTS.

    How long have you, or your family, ever had to wait in an ED, Dr. Seigel?

    Colleen Robert
    Vancouver, WA

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  77. Dr. Siegel,

    It is crystal clear, that Dr. Jones has a backbone, while you are obviously a coward. You are obviously a bleeding liberal who is satisfied with whatever the Progressives in the United States Government want to send your way. I am in the Army, and I am horrified at what the people who support you on this blog believe to be acceptable behavior in America. You are a coward, and you should be ashamed of your selfish beliefs. It is you that is the pompous idiot here.

    Sincerely,

    David

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  78. Dr. Siegel,
    Your comments are what makes America a beautiful place to live. The outlooks of many are powerful and opinions are what makes this country tick. But unfortunately, today's society is a ticking time-bomb of sorts. There is too much finger-pointing and not enough compromise. The healthcare situation is one that, no matter how ANYONE looks at it, there will always be a difference of opinion. And, more importantly, there is no "right" or "wrong" answer.

    I admire your grace to basically say, "You know what? Yes, there are patients who struggle from addiction or poor health practices, but at the end of the day, I'm a Doctor, I took an oath, and these patients' needs have nothing to do with race, taxes, carelessness, or poor health-related decisions."

    To put it bluntly, screw Dr. Jones' letter. We cannot, as a country, keep combatting these healthcare policies because, at the end of the day, no one wins. And, the funny thing is that it's not even about winning. It's about healthcare, but for some reason, it seems like there is a competition going on.

    I applaud you, Dr. Siegel for speaking up; to draw the attention back to the grass-roots reality that patient care is first and foremost, not about passing judgement and over-examining a patient's chart to pick out everything they have done WRONG to themselves...then writing open letters to the President about how our culture-crisis is ripping at the very fabric of our healthcare system.

    Thank you for looking at your ability to care for those in pain, suffering, or need of medical attention as a privilege.

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  79. The original item by Dr. Starner Jones caused me much distress and sparked some good virtual discussions with friends, as well as some regrettable anger on my part toward the acquaintance who posted it on Facebook.

    I merely want to thank Dr. Siegel for posting his response, and to commenter Ravkari. You are good people.

    -JSA, Santa Barbara

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  80. To all:

    1. The "ERs must treat everyone for free" law that has this kid so bothered was signed when he was in diapers -- by Reagan. That means it cannot be Socialist, since Reagan is God Of Capitalism. Right?

    2. He advocates a "culture cure." But you cannot stop people from buying lottery tickets, booze, or ringtones. So what is his cure? Can I be the (apparently) hundredth person to guess "forcing everyone to buy insurance?" If that's the case, shouldn't he be madly in love with Obama?

    - Rich R.

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  81. I'm with Dr. Siegel. The letter definitely had an undertone (racial or social) suggesting that all Medicaid recipients are pissing their money away. Is Dr. Jones suggesting that Medicaid is a bad program that we shouldn't have at all? I'm guessing he has probably never been faced with having no healtcare coverage. Maybe if he had walked a mile in his patient's 'expensive tennis shoes' he'd have a bit more perspective.

    Since when is it the doctor's duty to make judgements about a person's lifestyle and appearance? The only 'cultural crisis' evident in this letter is the state of professionalism in US medicine (and I'm glad to see Dr. Jones doesn't speak for all doctors in this letter).

    Thank you Dr. Siegel, you give me hope.

    American in the UK

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  82. I agree with Dr. Jones - I am an RN that works in a NY Urgicenter for kids; it's part of the ER. I see abuses of medicaid all the time. We now have a culture of entitlement, lack of responsibility and lack of accountability. Families come in to the urgicenter on medicaid with lexus cars, new clothes, jewelry and of course the latest IPhone. Yet they can't spend three dollars to buy a thermometer. All too often they come in and say "I think my child has a fever" I'll ask did you take the temperature and they reply "I don't have a thermometer." Something is definitely wrong with this situation.

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  83. Dr. Siegel, give up trying to educate the uneducatble. Currently, there can be no doubt that the most dangerous condition in our country is a vast epidemic of ignorance, grossly inferior education, and the deteriorization of the independant media, particulary beat reporters.

    On Bullshit
    Harry G. Frankfurt
    Winner of the 2005 Bestseller Awards, Philosophy Category, The Book Standard

    ....should be required reading to receive a college degree on any kind.

    Ultimately, the ignorance and lack of true education in our country, (intellectually worthless courses of study such as business, education, etc.)has left us with an American public that is devoid of any intellectual or factual basis to discern and distinguish those who espouse facts from those who espouse agenda laden loose and inflammatory tripe. I see no solution in the near term. I truly beleive that we are well on our way to the fall of the American empire...the rise is clearly over!


    Required reading

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  84. In reading the comments here and others I have seen on the internet regarding this letter from Dr Jones, I am struck by the mean spiritedness of many. In a physician, the judgemental attitude of Dr Jones is particularily sad. To think that he regards some patients with such obvious distain is a sad commentary on how the practice of medicine in this country has deteriorated into a money making business instead of a healing practice. I am glad his name is out there so I can make sure my well being is never in his hands.

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  85. Craig,

    What was Dr. Jones' patient's race and what in his letter led you to that conclusion? I would appreciate the help as I can't find any reference to race in his letter despite the numerous opponents, including yourself, shouting racism.

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  86. Seeing as everyone is heated up over this I hope you all are voting and talking to your representatives, cause blogging sure isn't changing public policy.

    Whether or not Jones' choice of words was appropriate he and Siegel bring up important points. Interpreting healthcare based on possible scenarios for this woman really is meaningless since there is a spectrum of people with this picture that legitimately benefit from or unfairly capitalize on Medicaid.

    If we want a safety net that absolves individuals of responsibility and bankrupts the country we can do that. Or if we want an economical system that forces people to be accountable and subjects certain vulnerable populations to suffering we can do that too. What do you want to pay for America?

    I took the Hippocratic Oath as well and there is no question that in the patient's room you do everything in the best interest of the patient, without ever considering who they are or where they come from.
    In healthcare operations however, time and resources spent in one place can't get used for another person in any practice, so as hard as it is, asking the question of whether or not I can give care effectively is just as much a physician responsibility.

    "I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm."
    --Modern Hippocratic Oath

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  87. I think if Doctor Jones would have described a patient as an overfed man with a a spray on tan, tooth veneers, a pricey cowboy hat, an expensive bible and a Hank Williams ring tone on his phone, the teabaggers and religious right would have cried foul VERY loudly at such a stereo type! Being a white woman living in Oakland, CA with a large black population, it is laughable to think that this doctor is not describing an obvious racial stereotype. I've noticed that to simply point this out is to risk being labeled a racist, which is the knee jerk reaction du jour of the racist set on this subject. Having worked in an ER for 13 years as a respiratory therapist, I can tell you that if an MD that is too busy judging his patients he cannot effectively do his job. No matter WHO he is judging, he is not doing his job. FYI, where on earth has Dr. Jones been hiding? Unless you are very young and healthy, you cannot go out and buy health insurance. My husband has had type 1 diabetes most of his life and is uninsurable, ie, the insurance companies can't make money off of him despite his healthy habits. Thank god, for now, he has a job with health benefits. Dr. Jones is obviously disgusted with many of the patients he sees and should therefore find another line of work since it is impossible to provide thoughtful, quality care in this mindset. Thanks so much for your wonderful insights, Dr. Siegel!

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  88. Lack of personal responsibility, lack of accountability, no work ethic, that I too see all too often as a paramedic. Race had nothing to do with the comment to a very real problem (Not jsut healthcare by the way...)!

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  89. I completely agree with you, Seigel. Let me also add that it is the same capitalist consumerist culture that Jones vilifies that has cultivated the antipathy I see in many of your readers' comments.

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  90. It may be the job/duty of doctors to provide care to patients such as this, but that doesn't mean I have to contribute to funding it. Similarly, I happen to be pro-choice but if any woman wants to have an abortion, that doesn't mean I have to have to contribute to funding it. Due to economic times, I've been unemployed for fourteen months. Does that give me the right to seek any sort of free medical care I can find? Those of us that respect ourselves for accountability think not.

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  91. I'm a single mom with a disabled son. He is on Medicaid. I work. I am a high school teacher. There is a cultural crisis. Even though I work hard, I still feel embarrassed when I take him into the doctor. On a teacher's salary, I can't afford the care he needs. The point is that others who abuse the system...THEY HAVE NO SHAME! They could care less because they think they are entitled to it. By the way, I have ONE child. He is 9 and I made the decision not to have more because I knew I couldn't afford it. I work at a title 1 school and teach ALL minorities. They all have the latest and newest cell phones, shoes, gold jewelry etc.

    When I was in high school (which wasn't that long ago), you hid the fact that you were on free lunch. You didn't go around advertising it. At my school, these kids announce it! Again, NO SHAME! They are entitled to it...that's how they are RAISED!

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  92. Dr. Siegel,

    After reading other posts in your blog, it is obvious that you'd take issue with anything that wasn't supported by the liberal Democrat platform, so your disdain for Dr. Jones and his opinion are certainly no more valid that what Dr. Jones wrote to begin with.

    You said you were all for reform in the healthcare field? Well anyone with two working brain cells who isn't blinded by partisan dogma knows that the our government doesn't reform anything, it just screws it up worse. Social Security, Welfare, Medicare... You name it. All of it jacked up beyond any rational hope of repair because it is now so politicized that nobody could do anything without stepping on someone's cash cow. So government run healthcare, when it goes down like every other bloated bureaucratic titanic the government controls, will do nothing but place more financial burden on the middle class. Oh, and it will put the poor and uneducated even deeper into the Democrats pocket, which will serve them well come reelection time. If the reform part were so easy, why didn't we actually start with some reform? where's the reform to the Medicare system that the administration is banking on paying for a significant portion of their healthcare bill? Why not reform it first and then use real dollars to fund something in the future? Maybe because it'll never happen on anything but paper. They'll never save a dime and who'll pay for it when that doesn't happen? I will. The middle class will. Thanks, but no thanks.

    Personally, I have no more room for any of this BS. Our government, and the administration you undoubtedly voted for, spend money like it grows on trees. They blindly throw millions upon millions of dollars at anything, hoping that the votes they have purchased will outweigh the opposition come election time. If the American middle class were to ever cumulatively get off its apathetic ass and start holding every politician accountable, there would be scarce few who would ever support something the likes of the current solution to "healthcare reform".

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  93. Dr. Siegel,

    I just saw Dr. Jones' letter reprinted on FaceBook. I love your response.

    While I can see why many would resent having to pay for this particular woman's care through their taxes, I don't understand why so many people who have never struggled with poverty or who have managed to escape it - believe that everyone on welfare is a welfare cheat.

    The poverty level just climbed to 14.3% And the poverty line is not even high enough. Add to that the whopping cost of health insurance and there is a very real crisis!

    How I wish people would have compassion for those who are struggling. I believe that if there were not so much national anger towards *everyone* on welfare - including the many who are truly struggling - we might actually be able to implement a welfare system that would truly help people climb out of poverty.

    Thanks for your compassionate letter, it helped me feel better about having read Dr. Jones' letter.

    Janet Beatrice

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  94. -Could not agree with you more Dr. Siegel.

    Anyone that denies the racial undertones in Jones' letter most likely has trouble admitting their own prejudices. Dr. Jones bypasses the true definition of the healthcare crisis, belittling it to a mere result of the " shortage of quality hospitals, doctors or nurses." The true healthcare crisis is the millions of uninsured Americans.

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  95. To those of you who are talking about "personal responsibility", and not wanting to "pay" for someone who is not working. First of all, who said the woman isn't working?! Just because you have a job doesn't mean that you have as many choices as you think. I imagine that buying health insurance is not an option for her (health insurance is WAY more expensive than monthly cell phone bill). A report came out just this week -- 14% of the country is living at or below poverty level, which is $21,000 for a family of four. In Washington, DC, I can't even pay my middle class mortgage with that. Yes, there are people who game the system, but there are many more who are already working 2 and 3 jobs and legitimately need assistance. And speeaking of gaming the system, how many rich folks do you think are spending their own money on nursing homes when they get old? None, because they've all pow-wowed with their rich attorney friends and figured out how to transfer (hide) their assets so they can draw off of Medicare and Medicaid. The sick thing is that it's THOSE people who feel entitled to get away with that crap and then begrudge having to give even a scrap to the poor folk.

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  96. As a Medicaid nurse (RN), I completely agree with Dr. Starnes. It is your letter, sir, that is offensive, as you come off as a self-righteous soul, who is afraid of the publicity Dr. Starnes letter is getting. Why the nerve of those people getting upset at their tax dollars being spent in such a careless, useless way, if they scream loud enough, congress might actually listen & then they way you get paid, might be changed in a manner you won't like! I've seen the abuses of the system until I'm sick of it! You haven't! You're not the front line MD, you're the one people come to, after they have a proven pay source!!! If you want to prove your point, why don't you discontinue your paycheck & practice for free to these people who spend willingly on themselves so that we the taxpayers can pay all their medical expenses? My insurance just went up over $1000 per month & people like you are part of the reason why!!!!!! Try living on earth like the rest of us and having to go without so you can pay for such as this & I guarantee that you will change your mind in a heartbeat!

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  97. Even thought I completely disagree with your perspective Dr. Siegel, I certainly do commend you for approving so many posts that voice opposition to your point of view.

    I have to give you a lot of credit for allowing such a spirited discussion. Most ideologues would probably find giving opposition an equal voice too distasteful or uncomfortable to allow.

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  98. Principled, not self-righteous.

    As for working on the "front lines," who do you think is called in the middle of the night to care for the uninsured patient in cardiogenic shock needing an emergent trip to the cath lab?

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  99. Paul Melkonian MassachusettsSeptember 17, 2010 at 9:55 PM

    There wasn't anything racist about the original letter. It's not uncommon these days for people who have no basis to argue with reasonable positions to scream racism. The corrupt Charlie Rangel once went so far as to say, " 'Tax cut' is code word for [the n word]."

    Don't flatter yourself by saying you are principled. What principle is it that says productive, responsible people have to pay for those who won't be (not can't be) productive and act irresponsibly?? I don't get all upset over it, but I do get a little peeved seeing a fat family at the supermarket, buying nothing but junk food and full sugar cola, and paying for it with an electronic benefits card. So basically, I'm paying for their food now, and I'll be paying for their insulin later.
    It is attitudes like the one expressed by your 'open letter' that are at the root of much that is wrong with this country.

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  100. I completely agree with you. Took the words right out of my mouth.

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  101. Dr. Jones didn't mention race? Are you serious. It's lesson time.

    I'm an healthcare professional and a journalist. As a journalist we are required to paint pictures in people's minds. You can strongly insinuate race without saying black, white, hispanic, etc.

    Answer the following question(s). What ethnicities come to mind under these descriptions:

    1.)young man walks in with freshly polished cowboys boots listening to the latest Kenny Chesney album on his iPod. (what initially comes to mind)

    2.)The people who upkeep my yard are a family of harder workers, but unfortunately they do not speak good english. (whats initially comes to mind)

    Though these examples are from strong stereotypes,they still paint mental images of people. When Dr. Jones said "R&B ringtone", a black face had to came to mind. And if it didn't, you all are lying.

    Dr. Jones knew what he was doing. This letter definitely has racist undertones.

    Is "culture crisis," a "black cultural crisis?" He should given more examples that described other races, or omit certain details that would not highlight his conscious or unconscious racist ways.

    Dr. Jones letter is unacceptable.

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  102. As a healthcare professional, I found Dr. Jones' comments particularly disturbing. I agree with Dr. Siegel wholeheartedly and commend Dr. Siegel for having the courage to speak out. Thank you Dr. Siegel!! No matter what other commentors say, I appreciate your courage and respect you as a healthcare professional for voicing your opinion and rightfully so!!! That took courage and guts!! Thank you for standing up for what is right when at this moment it may not popular to do so!!! Again, I say, Thank you!!

    The reason why I found Dr. Jones' comment particularly disturbing is because as a health care provider, we are not to pass judgement and to do so in a public forum, as such, questions his prejudices against patients as they enter his emergency room. Will he do all he can for a patient because he has pre-judged this patient? Will he allow this patient to die because in his judgement they are not an asset as a citizen or will he do all in his power to save their life? All of these questions immediately come to mind as I read his letter. I, too, thought his comments had racist undertones in the description of his patient.

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  103. Let's get real people...no one will ever solve this problem. We have become a society that rewards those that don't contribute anything to the well being of others. So what are you going to do about it? There is nothing you can do without taking help from those seriously in need.

    I am upset that people don't let this doctor say what he wants to say as a member of society. At no time did he say he did not provide care to this patient.

    It really upsets me that one of the comments said doctors take money from the taxpayers. We have to pay it back no matter what. We take the risk and we deserve to get paid. I am a doctor living in a 1 bedroom apartment because my school loans are so mind blowing. To say that we make so much money is completely ignorant.

    I can't tell you how many times I have seen people abuse the system. Not just the government programs but private programs. I have had patients that took free vouchers from exam plus glasses with their designer purses turn around and get contacts. And I can't say anything about it. I have another patient on Medicaid that drives up in her brand new Hummer.

    Don't even get me started on the number of diabetic patients that don't follow the advice of the doctors. Why even take assistance from the government if you refuse to take care of yourself?

    I am not an Obama supporter but nowhere in the doctor's letter did he mention Obama. This letter could have been addressed to any of our past presidents. This problem is NOT new. Medicaid IS socialized health care and it has been around long before Obama. He was simply addressing his concerns for a system that has failed. Obviously this is something that a lot of people feel strongly about proven by the vast number of responses to his letter. At least he got us talking about the problem instead of burying our heads in the sand.

    We should really look at what his message really was....quit eating fast food and being a lazy butt on Medicaid. If you were living a healthy life, you wouldn't need his care. He is an honest doctor telling us to be healthier.

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  104. Dr. Jones's attitude toward his patient, as expressed in his letter, is the issue. He is judgmental. He conveys a tone of disdain and disrespect. As a fellow physician, I find it unacceptable, which is why I chose to respond as I did.

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  105. Craig,

    Seeing a patient in cardiogenic shock going emergently to the cath lab for a PCI and IABP is a rare bird, depending on where you work. I wouldn't call that front lines.

    Again to a previous point, I saw a gentleman in the ED who had recurrent kidney stones. Seen days ago at a local hospital. Has medicaid. can't be seen by their urologists because he has medicaid and they don't take his "insurance". I called our urologist and told me he felt like he was getting "dumped on". How do you think I felt. We get dumped on all the time in the ED. but I happily see all the patients and treat them all the same. It is my job. but my question for all the people judging Dr Jones, what do we do outside the job to help the healthcare situation but blog about it? It is easy to judge other people and to use words than to make a difference by taking action.

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  106. And what action, exactly, did Dr. Jones take? We as physicians are obligated to hold each other accountable. That is the whole purpose of peer review.

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  107. Dr. Starner's letter serves to inflame and encourage the worst qualities in humanity. I agree they paint a stereotypical portrait - a poor and thinly veiled attempt at racism. Physicians are trained to base their decisions on science and data, not on a few bad experiences in the E.R. Dr. Starner has done a disservice to his profession.

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  108. Three things-

    This has been a busy post, and it is apparent that many of the writers did not read each others' comments thoroughly. As an educator, I know that what is at the heart of the matter is the tendency to take some evidence and make conclusions that will not stand when more evidence presents itself. That is a "culture crisis" whose creation and continuation should be the real work of all of us to discover and heal. Why are we not a nation of many deep thinkers? Hamilton and Jefferson argued about which citizens should be voters, and this question was part of it.

    There has been exploitation of public resources by private corporations and individuals since this country began. It is often called a good business practice (ask the banks, miners, and ranchers), but when it is done by the poor, it is criticized.

    Ruth Gentry published "Generational Poverty" some years ago, and it might be helpful for us to include it in our education of teachers, administrators, attorneys, and health care workers. Many of the choices poor people of all races make are ones that help them survive in difficult communities. Middle class and wealthy class people also live in communities with hidden, unwritten rules. Live by those rules in the poorer counties and you die, just as the poverty class rules cause devastation when walking in the more affluent worlds.

    If people understood earlier the true costs of their lifestyle choices, they might make different ones. If mentors and teachers understood the influence of adolescent brain development (age 9 - 19) on good judgment, they might be able to circumvent it better. If we all challenged the message that any of us "do it on our own," we might be more grateful for the support we have gotten from each other and our government, and be ready to give more, and mentor more, and challenge more. If more of us wrote our representatives, they might have less time and inclination to follow lobbyists and contributors who are promising to get the votes for them. If we challenged media, advertisements, pundits, and entertainment more, even in our own minds, we might get used to productive argument with each other.

    Thanks for allowing space for all of us to speak. Now to write my senator.

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  109. Dr. Siegel, thank you for this. I've read Dr. Jones' letter, your response and the all the comments that followed. I am saddened by the response of so many people. I would call them ignorant but after all this I realize that I am the ignorant one. Although I know people can differ in their opinions and political beliefs, I've always believed people were good. As I understand it, one of the main roles of a modern, progressive, ethical society is to look after each other. The poor, homeless and those with less no means are and should be take care of by those with more. Like many who have responded to your article, I come from a lower-middle class family. I don't feel the need to give the trajectory towards my current position in life, but needless to say, I've worked very hard to get where I am. I too pay taxes. I live in NYC so taxes here even a bit more than other parts of the country I've lived. But, I survive. And I will continue to do so. Again, I am so sad to read the people who have responded here really feel that they have worked hard and that it is not our duty to look after other. The obviously racist undertones (anyone with eyes to see cannot dispute this) is a part of the bigger problem. Some deny the racism, I cannot even address that because they are either truly ignorant or delusional, but for others, Jones included, there is a section of society that need not be cared for. Some on here have said thing along the lines of certain people learning to work and therefore abuse the system. The absence of any recognition of systemic racism in this country for over 200 years is mind-blowing. People really think racism no longer exists. That's what is most troubling. Or even more that the systems of racism in place for centuries were quickly and completely undone by the civil rights movements of the 60's. Americans are bad historians and that is a shame. Still I know your point is that as a medical professional Jones was out of line and inappropriate. I thank you for that and I thank you for the kind of care you provide our society. I pray for more Dr. Siegels and no Dr. Joneses.

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  110. I was so releived to see your comment. It seems his post is making it's rounds again on Facebook but this time, it has struck a different chord with me. I have written the following comment in response to people who seem to be rooting him on or their friends might be saying insensitive remarks.

    "Over the course of one night, two weeks ago, I became an unemployed widow in her early 40s left with 3 young children, a dog, a big unpaid house and two unpaid cars. I think I'll be ok when all this initial paperwork is complete, but during this transitionary time of several months(??), I will be partially, but significantly dependendent on our government's Social Security program. Whether someone chooses to purchase a stainless steel juicer, a nice bottle of wine, imported kitchen lights, video games, concert/game tix, or tattoos and gold caps for their teeth is COMPLETELY nobody's business. When it comes down to it, we all make foolish or recreational spending decisions and it is NEVER ok to judge someone by their socioeconomic status, race, luxuries or "urban" accessories. Please "be kind and rewind" your thinking to each individual sitiuation or better yet, just look into a mirror and worry only about that. And then carry on in your best and kindest way. -lou"

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  111. I agree that it as a slap in the face that supposed poor people use social programs yet flash luxuries while the economy takes its toll on the rest of us who deserve the suffering the least. Yes, they are taking advantage of their situation and it is morally wrong. Unfortunately it is not criminal and the system is set up to allow it. Don't hate the player, hate the game. Make your representatives do their job and change the way we qualify people for those programs.
    People who cannot afford to have children and still do are the biggest problem this system faces.

    This doctor went out of his way to describe an R&B ringtone and other things that are blatantly blaming black people for this issue. He is in Missippi (The only state poorer than AZ) and it may look that way to him. It is not true. The statistics say that more white people are on Medicaid than any other race: http://www.statehealthfacts.org/comparebar.jsp?ind=158&cat=3
    Distribution of the Nonelderly with Medicaid by Race/Ethnicity in US:
    White 42.8%
    Black 22.2%
    Hispanic 27.9%
    Other 7.1%

    I assume this "doctor" views poor white women and their children with compassion while he looks at a culture he does not identify with or understand with distain. I view him as an intolerant prejudiced hypocrite. I don't believe people who make personal judgements based on shallow criteria belong in the field of medicine.

    His motive for publishing this letter last year was actually to say that this issue outweighs the need for a health care bill that will stop big pharma and insurance companies from taking advantage of us. In the long run, we allowed their lobbysts to destroy the health care bill and make it almost worthless. Private doctors who are directly paid by insurance companies and are paid off by big pharma were a major cause in that problem and I hold them accountable for it.

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  112. It's trendy to be intolerant. Dr. Jones offers nothing.

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  113. Dr. Siegel
    I just wanted to say thank you for standing up to this preposterous Dr. Jones "letter" (and may I also say a very old and tired argument) that has been circulating all over FB. It has gotten me pretty fired up. It was refreshing to read your response. Even some of my own family disagree with me on this subject. Many of my friends and family re posted this preposterous link on their FB profiles, applauding it loudly I just wanted to share my response to it with you. I posted it on my profile as well and then added this comment:

    Agreed, I have seen the picture Dr. Starner Jones painted above, many times. I have worked in the E.R. 10 years as a nurse, and another 9 years in OB as a nurse and what he just described used to bother me alot. However, notice this woman's healthcare is ALREADY being paid for, and many people like her have had their healthcare paid for many years now. Not every person who relies on Medicaid is as he described. Sure, you will always find someone who can "work the system" whether it involves healthcare, disability, social security, food stamps etc. We may be able to... educate/rehabilitate these people, it may or may not help. However, part of what the president is trying to do is help people who are stuck in the middle, some are very honest, hardworking people but make too much for medicaid, yet cannot afford health insurance (my parents fell into that group). The new laws going into effect are going to benefit families like my own. My daughter had cancer, not because of a poor lifestyle, or environmental factors. This type of cancer just happens. Laws are being passed to keep insurance companies from excluding someone because of pre existing conditions or because their healthcare suddenly has become too expensive. We have health insurance, yet we are deeply in debt due to health care costs (and will be for a long time). Not everyone out there is acting irresponsibly, I am so tired of hearing this argument. Sadly, it took being a mother of a very ill child to see the other side and realize there are many out there who work very hard, live responsibly, yet neglect their health care because they cannot afford it, and they have no insurance.
    I feel alot of our problem is related to the greed of insurance companies, they are not suffering during this healthcare crisis and have plenty of money to go around, yet continue to raise our premiums, raise the deductibles and decrease coverage!!
    And then there are those who don't have insurance, they come in to the ER to be treated and submit a "hardship" form, (due to EMTALA laws they must be treated whether the hospital receives compensation or not) they don't pay a penny and the hospital writes them off, hence an increase in charges to everyone else to cover those who get free care. If only Dr. Roger Starner Jones solution was that simple. It's not about rewarding irresponsibility, rather let's start being responsible in caring for others.

    I know the originial version to this so called letter was written last fall, and that was when tensions were at the highest level regarding universal health care. I know this so called Dr. wrote this "letter" in response to the (then) proposed universal health care. It was totally ignorant (not to mention extremely low) of him to point out that this "culture" he spoke of is the reason for our healthcare mess. I have not heard very many people mentioning anything about the insurance industry, nor pointing out how THEY have 3 or more Porsches in their driveways and own several vacation homes, yet the rest of us continue to struggle while the health insurance industry continue to make bigger profits.

    I would also like to say thank you for being responsible in caring for those who are unable to pay or who have medicaid and putting their health care needs first. I know of many cardiologists who would not except a "self pay" or medicaid pt.

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  114. "It's trendy to be intolerant".

    No, it's trendy to be able to keep your own hard-earned money instead of having to pay for someone's health care so they can purchase gold grills and cell phones with custom ringtones.

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  115. Totally empathize with Dr. Starner. Cannot deny the fact that it is a "joint flaw". As a fellow healthcare worker, it is one thing to treat patients who is placed infront of our hands regardless. It is another thing when the "culture" and the healthcare system enables such behaviour. To make a law so as not to abuse the system and makea culture change is not a punishment. It is just a normal consequence of poor choices they make. Average cellphone bill is $ 120.00 monthly, daily booze $ 20/day = $ 600.00/month. That is more than enough to pay for an insurance. Enough to see a counselling to deal why they choose booze or whatever in lieu of healthy choices.
    I still treat my patients with dignity, with respect, smile at them, put on make up and dress up infront of them, stay cool, calm and collected even when verbally abused...it is just sad because the "culture" and the "h-system" is in so much denial for a major reform. To be forced to be taxed and pay for their heakthcare is just a double whammy to all healthcare workers not just MD's.
    My point?...don't want to minimize Dr. Starner's frustration.

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  116. Dr. Siegel, how did Dr. Jones' letter have racist overtones? He never mentioned the woman's race, and a reference to culture could mean anything. If you believe he is casting judgment on a certain race, it's due to the assumption you made about her race, which means you're the one fomenting stereotypes.

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  117. That is a ridiculous argument, and not even an original one at that. The patient's racial background was painfully obvious from Dr. Jones's description of her in his letter, to the extent that identifying her race would have been redundant. That was his intent.

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  118. It's funny how this letter is over a year old. Oddly enough it comes up during an election cycle and is viral on the internet right now. Some of his letters are actually addressed to the President. Which is incorrect. How about we all look at the bigger picture here and stop being pawns for political parties.

    And of course it was obvious what kind of person Dr. Jones was referring to. He's in Mississippi. He didn't describe the patient as a tobacco chewing, Snakeskin cowboy boot wearing person, with a gold belt buckle and bracelet driving a brand new F-250 crew cab right?

    You can get some pretty good knock offs on Ebay BTW, and craigslist sells iPhones in my area for $150. Health insurance can cost between $6000-$10,000 a year. I think $300-$500 worth of crap wouldn't cover it. I know it's hard to put yourself into those shoes, but if you try you might have a different opinion.

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  119. Thank you Dr. Siegel for at least opening the discussion about the problems I see in the healthcare debate... the idea that the poor or uninsured are undeserving. Some might be... but MANY are not!

    While some of the people using Medicaid or Medicare may come in with tattoos and pricey clothes to the ER where the letter writer works, for every one person like that (which the ER sees a higher rate of I assure you!) there are probably 2 or more like me and my first husband.

    My first husband had a congenital heart defect which required that at age 18 he had a pacemaker implanted, and as a result we could never afford the $4,000-$6,000 a MONTH that most health insurance companies wanted to insure him. Thankfully, he went to college, and afterward he worked at a good corporate job and was able, for a time, to have decent healthcare coverage via a group plan that paid for things like his pacemaker checks and regular care.

    Well, at the age of 32, it was discovered he was in heart failure. The damaged and repaired heart he was born with just wasn't able to keep going much longer. Guess what happened then!?!? Because he wasn't able to work, the company he worked for (where he just landed a DREAM job that paid well - it was a LARGE Multi-national INSURANCE COMPANY!) let him go... because of course, since he just started there they did not have to give him Medical Leave under the FMLA laws. So... $80k a year job = GONE! Health Insurance = GONE as well! So what do you do THEN I ask?

    Well, I'll tell you, I watched my husband turn blue in a hospital bed at the young age of 32 because he couldn't get a heart transplant. Not that the hospital or doctors or UNOS wouldn't GIVE him one... NO... he was a candidate... but they could not transplant because he could not, without insurance, afford the $5k in anti-rejection drugs he would need to stay alive after the transplant. The social workers did everything they could, but because of the way Medicare and Medicaid laws worked, my husband didn't qualify for insurance because he hadn't been disabled at least 6 months. It was a nightmare. We finally ended up writing our Congressman (Sen. Russ Feingold of WI) and his office was able to push through an exception to the usual Medicare/Medicaid/Title 19 rules so my husband could get his transplant.

    So... you can be a hardworking person. You can pay into the system and be a "successful" and "productive" member of society. But you better PRAY you don't get sick! And quite frankly, I am TIRED of this attitude that the sick and poor are "undeserving" - that we are uninsured because we are lazy or stupid. I assure you, my husband and I were neither. But... what we were was UNFORTUNATE. To deny healthcare to the poor might deny care to people who (in the letter writers mind) make poor decisions with their money and lives... but it also denies care to MANY more people who do not. To base the healthcare debate on stereotypes and racist (YES, this letter had decidedly racist undertones!) rhetoric is a slippery slope. Who then, becomes "Deserving"?

    My first husband passed away from pneumonia 2 years after getting his heart transplant. During those two years, he did everything he could to work and live a "normal" productive life.

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  120. So... my story continues:

    I am now remarried, and have been blessed with two beautiful sons. My second child was born three weeks ago and it was discovered he has a malformation of the Aortic valve in the heart (Moderate Aortic Stenosis), which will require surgery - probably sooner rather than later. As parents, my husband and I are terrified that our little baby may have to have surgery so young, and may need follow-up surgeries more than once to replace the valve as he grows. The SICK part of it is that what we also have to worry about is the cost and whether we can afford it on my husband's modest insurance agent's salary. Even though we have group insurance, the birth of our son alone cost well over $4,000 out of our pocket...no small sum when our family only earns $39,000 a year!

    AND we also worry that, no matter how much we do to make our son well, once grows up and he leaves home and no longer has the benefit of group healthcare coverage from his parents, that our precious son won't be deemed "uninsurable". If that happens and something goes wrong with his heart again, we worry that HE won't be the one I watch turn blue in a hospital bed. That is more terrifying than anything I can imagine. I know the pain my first husband suffered at the hands of the system and the insurance companies, and I cannot imagine having it happen to my son. Everyone has the right to LIVE! I'm sorry, but America needs to get out of the dark ages and get at least some sort of affordable health care system that EVERYONE can fall back on in times of need!!!!

    So... Dr. Jones... I challenge you to live in my shoes. I challenge you to leave the ER for awhile and SEE how other low-income or un-insurable people end up in the health care battle. I assure you, we're not all the "undeserving" ghetto trash you make us out to be.

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  121. Harvey Norris, MSW, LCSW said...

    I'm sorry, but the 200,000 that Doctor Roger Jones borrowed for his medical education does not make him your indentured servant. Almost everybody takes out federal loans for college, graduate school, and doctoral programs. According to your logic, every lawyer, teacher, engineer, (pretty much everybody) and other students accepting government loans or attending public schools owes a debt to society. I guess that legal care, teaching, and all other services must be free based on your logic.

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  122. Patricia White, MT (ASCP)September 20, 2010 at 12:53 PM

    Dr Jones presents one side of the story. The other is my sister who, after working as an RN for many years, was afflictd with Alzheimers and could not get health insurance after she was fired from her job(she worked as an RN in a mental health facility and no one seemed to notice the change in her brought on by Alzheimer's, instead they fired her)due to a "pre-existing condition". I agree that we need to clean up the system, but there are many Americans who have not abused the system, have followed the rules and are now without insurance. Emergency Department care is much more expensive than other forms of healthcare and one way or another, we are going to pay for it. As the wealthiest country in the world, we owe it to ourselves, our children, and our fellow citizens to find a way to make sure everyone has basic healthcare insurance. Where is our humanity and our "Christian" ethics.

    Patricia White, M.T. (ASCP)

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  123. You all are missing the point, the Dr wasn't judging people due to their taste in clothing, food and tattoos he was saying "if you have money to do all these things then why are you depending on the government for healthcare?" Really I didn't think it would be that hard to understand.

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  124. Many in America in this heated debate can benefit from reading Theda Skocpol's book Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States.

    By the late 1880s, the Civil War pension system provided benefits and pensions for a large number of elderly men, their widows and dependents (Skocpol, 1992 p.1). Some viewed the system as an early national welfare and health cared system due to how much it cost the federal government and amount of citizens it covered. Pretty much if you were a white male or female and backed the republican party you got the benefit! The many Americans at the time viewed the Civil War pension program as an example of government excess that propagated by corruption. The sentiment was that the Republican party of that time used the system as patronage for supporters and thus was viewed as a model of political corruption (Skocpol, 1992). The political climate of the Progressive era was one that focused on curtailing corrupted programs such as the Civil War pension program. Thus was not any such federal program till the Great Depression lead way to programs such as Medicare.

    The short term implications of this was that the United States (US) did not follow the trend of other Western countries who enacted legislation that initially protected working men and eventually for all citizens. While in contrast the United States chooses to enact legislation that protected women and children. Skocpol (1992) argues that the United States has not ever been a “modern welfare state” in comparison to other Western countries such as Great Britain or Sweden and that it is likely that the US will never develop welfare programs found in those countries. It could be hypothesized that the long term consequences of the resentment caused by the Civil War pension system was the US not creating a national health care program. In the United States there is an over whelming negative connotation to the term “welfare.” As Skocpol (1992) writes: “It refers to unearned public assistance benefits, possibly undeserved and certainly demeaning to be avoided if at all possible by all “independent,” self-respecting citizens.”

    Pretty much America has set up a system where who you know in power is how you get things such as benefits. Tax breaks for the wealthy, Government subsidies... farming subsidies... big business bailouts.... strange... but I think that is welfare friends...



    Reference:

    Skocpol, T. (1992). Protecting soldiers and mothers: The political origins of social policy. First Harvard University Press. Pages 1 - 63, pp 67 -101 and pp 535-539.

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  125. Thank you for this and the many other thoughtful and at times heartfelt responses to my blog post.

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  126. I didn't read all of these posts, I stopped when I got to Rabbi Kari. He seemed to have the most logical response I've read to this hidious situation thus far.

    It shocks and amazes me at the hatred this letter from Dr. Jones has stirred up. A sign of the times no doubt.

    I personally was apalled by Dr. Jones letter, and whether or not it was specifically spelled out, there were most definately "Racist Undertones"!

    I think this issue is much bigger than any one of us contemplates, and there is NO easy fix. But blaming it on Medicare recipients is NOT THE ANSWER!

    I aplaud Dr. Craig Siegel for his honesty, and he's right, you do take an oath, and that should mean everything to you as a physician, no matter if you are an E.R. Doc, or a Cardiologist! Or, for that matter, my Step Son-in-Law, the Perodontist! Although I doubt he will dare to see too many poor people in his career!

    Bottom line, this isn't going to get any better with hatred and finger pointing, we need to come together as a nation, not fall apart-

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  127. I need to make a correction to my post! It should read : "I think this issue is much bigger than any one of us contemplates, and there is No easy fix. But blaming it on "MEDICADE" recipients is NOT THE ANSWER!

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  128. Dear Dr. Siegel,

    I want to thank you for your thoughtful comments on Dr. Jones' letter to the editor. When I first saw this letter re-posted on a friend's Facebook page, I thought of the hateful stereotypes that I have heard over the last thirty years.

    I can't really speak of Dr. Jones as a person, because I've never met him. I did see some information on him via some fact-checking sites (e.g., Snopes.com), and I gather that he is indeed an emergency room physician. Generally, I have a positive view of doctors, but the letter struck me as being judgmental and unprofessional. Of course, this reaction was a somewhat emotional first impression based on little information

    As a professional librarian for the last 20 years, I always stress to people that they need to carefully scrutinize information in the press before drawing conclusions. I know many people will read Jones' letter and be sympathetic to his views based on this single anecdote, but we don't really know much about the patient and her situation . We know only what Jones tells us.

    If Jones’ message was that patients can empower themselves by making good decisions for their physical and financial health - and thereby take personal responsiblity for their lives, his harsh comments were self-defeating to that message.

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  129. Dr. Siegel,
    Thank you for sharing your views on the Dr. Jones letter to the editor. I stumbled across the "letter" that Dr. Jones wrote for the Mississippi Clarion Ledger and decided to see what people were saying about it. So far what has really shocked me is to see how how much his letter has been altered on its journey to Facebook. If you look at what is currently being circulated, you will notice that it is nothing like the letter that was published in the Clarion Ledger.
    The issue I have is that the letter that Dr. Jones wrote is an obvious Red Herring to get people riled up about the new health care bill. We know nothing about this women, other than that Dr. Jones saw a single hour long snap shot into her life. His critique may have been justifiable, but is anyone willing to deny health care to 30 million people because of the one woman that Dr. Jones saw abusing the system?
    I am going to offer myself up as a red herring to provide a counter example for all the people that have come out against the new health care bill that has been passed.
    I am a 26 year old male who is extemely active and a recent returnee from the Peace Corps. Before my time in the Peace Corps, I went to a UC school where for my final two years I worked an average of 30 hours of week. I sound like a pretty normal person. Well, insurance companies don't think so. The problem is that I played tennis at the division one level for my first two years of school. During my time on university tennis team, I had two shoulder surgeries that ultimately forced me to give up the sport. After my second surgery, I was fitted with a "pain pump" to help alleviate some of the post operative pain. This piece of equipment actually destroyed all the remaining cartilage in my shoulder, making even the simplest of movements extremely painful for me. Needless to say I can no longer play tennis. The other side effect that it has had on my life is to make me uninsurable. Now, I guess I could sue my doctor or the maker of the "pain pump", but that would make me part of the problem that is killing health care in the United States.
    There, that is my red herring. Its just one example, but if that is what it takes to get people to get over the all the new "health care queen" rhetoric that I have been hearing then I thought I would share it.

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  130. RACISM/RACIST... I can understand somebody reading Jone's letter and becoming preoccupied with such stereotypical comments. BUT if this becomes the the main focus, the point is lost. CHILL, watch some Mind of Mencia, and focus on the issues, HEALTHCARE, WELFARE, UNEMPLOYMENT, not STEREOTYPES. We should find some humor in stereotypes.

    BTW, Google 'Paul Wall'...

    NOTE: I've seen several references this letter has been altered since going viral.

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  131. I see no humor in racial stereotypes, particularly when propagated by a fellow physician.

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  132. First off I do not believe anyone who does not pay for health care or provides it has earned a right to deface Dr. Jones.

    I am a physician... I have worked mainly in public health... and I see what Dr. Jones alludes to every day. I don't want to brush my teeth... just let the government pay to fix them. And why should they when the government continues to do so at outrageous expense when a $2 toothbrush and some personal responsibility would have been much more effective.

    Dr Siegel... since it is our privledge... live by your words. Don't take compensation for your work... in fact refund the compensation you've received over the years. For me... it's not a privledge... it's a job.

    Indulging people's lack of care for themselves by supporting their unhealthy lifestyle and poor financial choices is doing them harm. I don't know about you... I took an oath to do no harm.

    You come across to me as a holier than thou high and mighty on his horse specialist.

    To those of you who crap on Dr. Jones for speaking about his observations you need to do this: You need to walk in his shoes first. You need to earn the right to treat patients... then do so in a setting he works in... and see what he sees on a daily basis. Until then you have no clue what you are talking about and your bashing makes you sound like spoiled children.

    As for racism... get real. There was no mention of race whatsoever... and those of you who insert the claim are more guilty of racism yourself. He mentioned costly cell phones and tattoos. Are you saying only members of a certian race have costly cell phones and tattoos??? I listen to R&B... I bump it all the time. I'm white as can be. Are you saying only members of a certian race listen to R&B??? THAT sir is racism. Shame.

    Dr Siegel my guess is you're a man who tells people what they want to hear... not what they need to hear. As such... you bear responsibility as part of the problem... and not part of the solution.

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  133. Sorry to hear the practice of medicine is just a job for you.

    Not quite sure how I can be holier than thou and racist at the same time.

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  134. I will keep this short and sweet. But hope the biased look at Medicaid and the really desperate individuals it helps, or saves. What I am writing is all true because it happened to me.

    I always wanted to be a nurse since I was a little girl. I began working in hospitals first chance I could at age 18, and gradually worked up the ladder before graduating from a registered nursing program in 1994. I volunteered with countless organizations, for free, offering my medical expertise to those less fortunate. Having worked in a very large county hospital, yes I saw people "working" the system, but I also saw the poor and helpless, the young and disabled, the elderly and dying.... I loved them all. They wee my patients, and I was responsible for their care. Their insurance status did not matter to me. I had always had my own insurance and led a very healthy lifestyle, worked out daily, watched what I ate, was neurotic about my body fat and nutrition. I was the epitome of health.

    I worked 3 jobs and volunteered for several 501 non profits for years. After 10 years of doing nursing non stop... I decided to take 6 months off and moved to a different state temporarily. 2 months into that trip, my fater died suddenly, and then two weeks later I was diagnosed with stage four lymphoma that had spread to my bone marrow and had a tumor the size of two tennis balls in my chest. I barely made it through that 2 week hospitalization, but spent my time and money racking up bills on 9 months of chemo, radiation, treatments ect.... all of which were unsuccessful and my cancer spread. I needed a stem cell transplant. I sent a letter pleading to the state that I was now terminal, and without this transplant, I would die. I was only 34 years old. Some angel at Medicaid granted me coverage, and after 6 months of hospitalizations, stem cell treatments, and horrible life threatening incidents in the process, I barely came out alive. I would be dead without Medicaid saving my life. I thank god every day for the life I have because of medicaid.

    My mission now, is to educate and help others who are ill with my cancer. I have gone back to dedicating my life to helping others and will do so for the rest of my life.

    Don't judge. For some of us, Medicaid is the difference between life and death. Morally I recognize this, and will spend the rest of my life contributing back to my community and others in need. It makes me cry when I read letters that are so hateful against people like me whose lives were saved by Medicaid. Its difficult for me to comprehend why in the world, anyone thinks that my life was not worth saving. It makes me cry. Its horrible to know or read what people think of me and others who are alive only because of MediCaid, and suggest we should have been left to die. Teary and heartbroken.

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  135. by the way... as the nurse who had the medicaid stem cell transplant... I will add this. I specifically never collected ss, welfare, or payment from the goernment of any kind whatsoever. I was so grateful for the insurance, I was so grateful for the oppourtunity to possibly live, that was all I cared about. I wonder if my doctors or some of the people with opinions that are so harsh against us literally desperate to live, would be able to meet us personally, hear our stories, and then be so horribly mean and judgemental. My life WAS worth saving, and I will spend the rest of my life and my medical background to give back to the commmunity and the greater good. I was not a sycophant, I was a upstanding young adult member of the community my whole life, I was very healthy, and the last person ANYONE thought would come down with such an aggressive deadly cancer. I did not cause my illness. Now that I am saved, will be giving back the rest of my existence.

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  136. Additionally for all the "medical" individuals who wrote their opinions, many hateful and resentful, against Medicaid patients, I would be happy to personally tell you and show you pictures of how healthy I was before my illness, proof of how well I took care of myself, and how my finances were desimated being a young single nurse, no longer working going through a year of very harsh treatments. I was young, I had not prepared for that kind of financial catastrophe and not being able to work, and I certainly had not saved up for a experimental tandem bone marrow transplant. Literally an absolute ANGEL at medicaid saw this young girl who was terminal, and gave me all state medicaid coverage. I find it completely biased and offensive when so called RN's or medical doctors write such generalized hateful statements about Medicaid patients. i was one of you guys, but now I'm part of that group you so frown on.

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  137. Dr. Siegel,
    Thank you! I think Dr. Jones and any health care "professionals" who jump on his band wagon have forgotten their oaths. I am amazed at how many foolish people don't see a single "racial" overtone in his letter. It's there and you never once called him a racist, just pointed out how his letter sounded. Jones may not be racist but he is !))% prejudiced and has a very narrow scope of reality which I find sad for one who is so highly educated. Obviously there ARE people who abuse the system but according to Dr Jones its just a simple matter of irresponsibility that keeps someone who is working for minimum wage from paying $1000 a month for health insurance. Those bastards!!! His letter is insulting to those of us who work are rear ends off to barely make ends meet, not only paying for our own families but also for those who are on Medicare. The same people who constantly criticize the work ethic of the young. I question the ethics of any Doctor who has the coconuts to write to a news paper ripping a patient to shreds, that is POOR form no matter what side of the tea bag you are on. I'm pretty sure none of the people who have a problem with leaving a human being on the side of the road to die simply because they don't agree with the way that person manages the whopping $150 in food stamps they receive per month would have NO problem paying twice as much to put this patient in jail. I bet that a good number of them also have the nerve to consider themselves "pro-life", what a joke. It makes me sick.
    DM

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  138. Dr. Siegel,
    If doctors are to "not to pass judgment" on those who live so carelessly "On the Dole," why is it that Obama, Bloomberg, Waxman, Boxer, et al are so vociferously trying to force healthier eating by limiting restaurants' (and school lunches) menu, their use of salt, etc? Are not doctors guiding/driving these actions?
    If not, why not?

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  139. Promoting lifestyle changes that will dramatically improve the health and well being of our patients is not passing judgment, it is a part of caring.

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  140. Oh my! After several months I'm startled to see that Dr. Jones' viral presence continues to enjoy far more exposure than it deserves, especially on a blog site devoted to swimming! Thank you so much for your comments, Dr. Siegel. I am at least glad that some of the responses here favor a more ethical assessment of Dr. Jones observations. Perhaps it is time to put the issue to rest, but I hope you don’t mind if I add another comment, this one about a few misconceptions I've seen expressed in this discussion:

    1)That the Medicaid recipient somehow contributes to the health care crisis. She is considered to have coverage and doesn't contribute to the problem of millions of working adults who are uninsured, under-insured, or who have become recently unemployed, catastrophically ill and dropped by their insurance companies. These issues, and none other, comprise the sum of the crisis.

    2)That it is somehow racist to assume that the Medicaid recipient is not a white, middle class American. Why is it so shameful to assume from the description that she is from a minority culture? Is there something wrong with belonging to a culture with distinguishing tastes and styles? We all have them, so why the hushed tones? The doctor emphasizes the term “culture crisis”; how pretentious (even racist) to avoid assigning meaning to this comment, so obviously not intended as benign.

    3)That the Medicaid recipient is only worthy of her “handout” if she presents herself as toothless, shoeless and wearing a barrel. About those luxuries: Marshalls, Walmart, and all the outlet stores have great deals on brand name shoes – cheap! A cell phone is a must - has anyone noticed the absence of phone booths lately? Gold teeth are a little more than porcelain, though not by much, but I’m afraid even a few more wouldn’t cover the cost of her annual insurance premium if she has a family. The pretzels...really?

    4)That Dr. Jones, as an insider in the medical field, is also qualified as an economist and social scientist.

    5)That Dr. Jones bears no ethical responsibility for inciting repressed hostilities toward minorities, the impoverished, or anyone else that could be positioned as a scapegoat during our economic downturn. Certainly, he is legally entitled to believe as he will and to speak his mind in his social or professional circle, but his calloused attempt to publicly erode the dignity of this individual, the culture to which she belongs and to which he is sworn to serve smacks of an ethical breach, I believe. Does he not have an obligation to understand the potency of his role as a professional and shut his mouth accordingly?

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  141. Hurray…for your write-up. At least you could present a complete picture on this topic. I have read many articles with started with this subject and in the middle lost the path. I really like your article and I am gonna share it on social networking sites.
    Kamagra

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  142. Open post to Dr. Seigel:

    Having read the good Doctor Starner's blog to the prez, it reflects what most of us "middle American" red state folks feel like. I went to CU, Boulder, like you. (BS+MS degree) I used to be a flaming liberal now turned ultra conservative and live in Texas. Guess I saw the light about 10 years ago when the Dem Party and ideals no longer represented my philosophy and thinking. Anyway, what Dr. Starner presents is not a "stressed" response, in my opinion, but a logical, well-thought-out deduction of the people who suck the system dry and expect handouts, get pissed when they don't get them. I have relatives in Hawaii that would rather pay 10 bucks for a pack of smoking (yucky habit!!) than pay for food, but they'd take food stamps in a minute and try to convert them into dollars to buy more cigs. What the brave doc is trying to say: "ENOUGH OF THIS NONSENSE!"

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  143. In the first place, it was a letter to the editor of his local newspaper, not a "blog to the prez." Second, I did not attend CU, and I am not sure how you concluded that I did. Third, while I will continue to post any and all comments on my blog, I believe that if you want to be taken seriously you should identify yourself rather than hiding behind "Anonymous."

    That having been said, I would ask whether in fact you are not your brother's keeper. I find both Dr. Jones's letter and Reverend Welsford's letter to the editor of Swimmer magazine (the subject of a more recent blog entry) decidedly un-Christian, which is all the more surprising since we are reminded on a regular basis that we live in a Christian nation. We all have the right to receive health care delivered in a caring and nonjudgmental manner. Dr. Jones does not seem capable of this and should consider a different profession.

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  144. http://online.wsj.com/article/SB10001424052748703673604575550243700895762.html
    The notion of karma comes with lots of new-age baggage, but it is an old and very conservative idea. It is the Sanskrit word for "deed" or "action," and the law of karma says that for every action, there is an equal and morally commensurate reaction. Kindness, honesty and hard work will (eventually) bring good fortune; cruelty, deceit and laziness will (eventually) bring suffering. No divine intervention is required; it's just a law of the universe, like gravity.
    In 1932, the great developmental psychologist Jean Piaget found that by the age of 6, children begin to believe that bad things that happen to them are punishments for bad things they have done.
    the federal government got into the business of protecting the American people—from market fluctuations as well as from their own bad decisions—under Franklin D. Roosevelt. During the Great Depression, most Americans recognized that capitalism required safety nets here and there. But Lyndon Johnson's effort to build the Great Society, and particularly welfare programs that reduced the incentives for work and marriage among the poor, went much further.
    Listen, for example, to Rick Santelli's "rant heard 'round the world" on CNBC last year and its most famous lines: "The government is promoting bad behavior," and "How many of you people want to pay for your neighbors' mortgage that has an extra bathroom and can't pay their bills?" It's a rant about karma, not liberty.
    One of the biggest disagreements between the political left and right is their conflicting notions of fairness. Across many surveys and experiments, we find that liberals think about fairness in terms of equality, whereas conservatives think of it in terms of karma.
    here's a statement about the negative side of karma: "Whenever possible, a criminal should be made to suffer in the same way that his victim suffered." Liberals reject this harsh notion, and libertarians mildly reject it. But conservatives are slightly positive about it.
    Between 1979 and 2008, the top 5% of American families saw their real incomes increase 73%, according to Census data. Over the same period, the lowest-income fifth (20% of us) saw a decrease in real income of 4.1%. The rest were just stagnant or saw very little increase. This is why people are borrowing more and more, falling further and further behind.
    This makes most of us chumps...at the expense of the wealthy!

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  145. You are all being gamed. The long and arduous discussion is proof of the effects. None of the 'solutions' out there are real concrete answers to the problem. Single payer health care is an absolute joke while most other reforms barely begin to address the monopoly status of health insurers from state to state. The government, through regulatory 'actions', has created an environment that enables health insurance companies to freely operate inside of their respective states with no competition.

    Where do you think the idea of premiums first came from? Who implemented it first? The private 'free market' or the government?

    Our country is broke and reality is starting to set in.

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  146. I just received Dr.Starner's "letter to the editor" in an email. While I agree that there is a healthcare crisis, I am so glad to see that you have spoken out against such bigotry and unprofessionalism. Regardless of whether a physician *agrees* with the impression they get about a patient's lifestyle, it is completely irresponsible to publicly judge them. I think there was enough detail about the patient's physical appearance and an internet search quickly reveals where the doctor practices..that seems to be a violation of a patient's right to confidentiality.

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  147. From the twelfth century writings of Maimonides ("Prayer for a physician"):

    "May I merit to see in the sufferer who seeks my advice a person, neither rich or poor, friend or foe, good man or bad. When I see a man in distress let me see only a human being."

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  148. May I add a late addition to this discussion?

    While we Americans get bent out of shape over stories concerning one individual abusing the system, I must note that a group of physicians and criminals were arrested after defrauding Medicare of over $245 Million. This type of fraud is doing a lot more damage than the few people that Dr. Starner pointed to.

    Also, what about the 44,000 uninsured Americans who die every year because they don't have medical insurance? What about our fellow citizens who file bankruptcy due to medical bills? This system doesn't work for us. It is as simple as that.

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  149. Jeez, people, if you cannot see that Dr. Starner's post is racial how are you ever going to infer that Dr. Siegel's is anti-Christian?
    Firstly, let me get it out there that I know that there are the truly needy that are owed our help. But for kicks and giggles, let's talk about the truly (and I mean this with the proper connotation) ignorant.
    Dr. Seigel, would you not look at an obese patient and not suggest a healthier lifestyle. Would you not tell a smoker to quit? Of course you would. You would absolutely evaluate your patient and then pass judgment. And you would probably continue to gently press those suggestions throughout care until the patient responded some way or another.
    Dr. Sterner's evaluation of his patient extended beyond the scope of routine E.R. exam (notice, that doesn't mean that he didn't treat the woman properly according to the purely medical findings) but he seems to have an ability to multi-task and observe another flagrant problem at hand. Perhaps the problem could be viewed like this: I have a patient that is overweight, I need to confront this issue as a cardiologist or I am guilty of malpractice. I have a patient that puts money toward material things and not toward medical insurance, I need to establish if he/she doesn't consider his/her health a priority.
    Now, I know that this is extreme, but I am a bit confused that the first is patient care and the second is ridicule of a patient. What if both patients are unaware of a remedy to their predicament.
    I guess what I'm trying to say is that don't see "only a human being" but a person made in the image of G-d and I have no issue with the spiritual work of mercy to instruct of the ignorant. For a society to tell someone to stop being entitled and remind them that they can expect more from themselves can be just as curative to the human condition as anything a cardiologist can recommend.
    best to all of you!

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  150. Hooray for Dr. Jones. From reading his letter, I did not get that he was unwilling to treat a patient, but rather was sickened by the fact that medical treatment was to be paid by taxpayers. I work two jobs and still do not have enough money to pay for medical or dental treatment. I don't have money for tattoos or special ring tones on own expensive sneakers. From personal knowledge, I know of people who abuse the system. They collect all they can and work "off the books" sometimes earning more than what I earn working two full-time jobs. This is the prejudice that Dr. Jones was talking about. If you want certain luxuries in life, get them, but not at the expense of a country that is in financial crisis. Why shouldn't I quit my jobs and live off the taxpayers? What if everyone did the same? Why are some more entitled than others? I have a disabled husband who cannot collect because I work and I support him as well as two special needs children. We barely make it on my salary. Those who do abuse the system should be ashamed of themselves, but unfortunately. Switch places with me for one month and see what happens if you don't pay the electric or don't have enough money to buy groceries, and you can't get anyone to help you. Will you still be buying those expensive sneakers? I think not. It's time for the government to make people accountable for the way they spend our tax dollars.

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  151. A good physician exercises clinical judgment in the care of a patient. Dr. Jones, on the other hand, passed judgment on the appearance and the presumed lifestyle of a patient under his care. Not sure why it is so difficult for some to recognize the difference between the two.

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  152. Taxpayer money is also used to provide welfare for multi-national corporations and the super-rich. If the people and Dr. Jones are going to complain about ``abuse`` of the system, they ought to be consistent about it, instead of just picking and choosing the parts they like. Oh, but isn´t that what fundamentalist Christians and radical Islamists do, as well? All extremists are of no use to those of us who wish to live in peace and moderation. Perhaps Dr. Jones is another Southern (Confederate) extremist, they remind me so much of the Taliban!

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  153. Mr. Siegel, why attack the person of Dr. Jones rather than the issue he is addressing? There is a problem in the system. Let’s talk about ways to fix it and help people rather than attack someone because their ideas or perspective are different than our own.

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  154. I attacked "the person of Dr. Jones" because his letter was unprofessional. He was judgmental and disrespectful toward a patient under his care.

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  155. There is a downfall of morals in our society. People need to be responsible for their actions. Maybe if we put more money into our education system and less into our assistance programs such as medicaid, we could put a stop to this 'downward spiral.' When I was a child, 20+ years ago, children weren't taught to disrespect their parents, teachers, and if they did behave in such a manner, they were held accountable for their actions.

    My point is, Everyone should be able to provide for themselves and their families. They shouldn't rely on government programs year after year. The assistance programs weren't originally designed for continual use, they were designed as a way to help those in need for a short amount of time. There are huge flaws in the 'system' that allow such continual misuse, which in turn required more support by tax payer dollars. I wish that people would try harder to support themselves and teach future generations the difference between 'needs' and 'wants.'

    Concerned in NC

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  156. I went to an American Emergency Room at an American Hospital and talked to an American Doctor for 7 minutes. It was the only place I knew of close to the airport that was open at midnight that would be able to see me. I had unbearable stomach cramps and diarrhea. The pain was incredible. I had already left a pair of underwear at a restroom at another airport.

    The diagnosis was that I had 'travelers diarrhea'. When he found out I had no Medical Insurance he canceled the urine test. I was prescribed pain pills and prescription Imodium. The cost to talk to this Doctor for 7 minutes or less was just over $1300.00.

    When I work (I do Union field construction) I pay $8.50 an hour for Medical Insurance. This insurance is inferior to Europe's 'Socialized Medical Insurance Plan' and really, you can only appreciate my extremely expensive Medical Insurance when there is a catastrophic problem that costs 10's or 100's of thousands of dollars. We have the highest paid and most expensive Doctors and hospitals in the world. No wonder this Doctor does not want things to change and blames the poor without insurance for a "culture crisis not a Health Care crisis". This heartless Doctor needs to look up the amount of people in the United States without Health Care Insurance and look up the costs of treatments.

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  157. Notice how the naysayers piled on Dr. Jones for his unprofessionalism and racism.... typical ad hominem attacks when there are no logical arguments. My thought is, if healthcare professionals aren't allowed to say anything about those they treat, who is? Is there anyone that can or should look at the healthcare situation with a critical eye? Are we going to wait for the responsible "government" entity to come to the rescue?
    Dr. Siegel, you and your ilk should feel free to open your wallet anytime you want to share. As for me, I'll keep my money when possible. Instead of tattoos and smokes, I'll use it for my necessities, and maybe my next doctor visit.

    Steve Eaton

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  158. Ad hominem? No, I attacked his arguments, specifically the notion that we as a society do not have an obligation to provide healthcare, a basic human right, to "the careless."

    "May I merit to see in the sufferer who seeks my advice a person, neither rich or poor, friend or foe, good man or bad. When I see a man in distress let me see only a human being."

    Maimonides (1135-1204)

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  159. Jones got it right. The abusers aren't the health care system or the banks it's the folks who are capable of paying their own way and don't who are guilty of abusing the system and of seems to be fraud. Today there are generations of Americans who have never known work. This group is much larger than 'anecdotal' and from my experience in the nonprofit sector it's pervasive and growing! As a country we can no longer afford this largess to the lazy. Bring our troops home, return the monetary system to the gold standard, and cut the spending at all levels of government.

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  160. Maimonides got it right because he never said "... and force others to pay for my charity. Forced charity never works because it creates a culture of dependency - the central point in Jones' original lte-gone-viral.

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  161. Dr. Jones made assumptions about his patient on the basis of her appearance. As a fellow human being she deserved compassionate, nonjudgmental care rather than being dismissively labelled one of society's "careless."

    Maimonides didn't use the term "forced charity" because it is an oxymoron. As Shakespeare wrote in The Merchant of Venice, "The quality of mercy is not strained."

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  162. I'm sure Dr Jones means no harm in his ignorance of the situation. He spent 20-30 minutes for which he will receive a hefty fee one he feels due and for which he would not like judged. Read the Hippocratic oath: It's now dreamed to be optional and most Dr's avoid it today. Money was not meant to be part of medicine, medicine is a way of life. Dr Jones like many of his colleagues today choose the life of a MD for the wrong reasons, he would probably been happier as a Wall St. trader. I myself am a rural village Dr, if someone needs my help it is given without judgment or thought of payment and I take pride in what I do, it's being human and humane. While a smile and a sincere thank you will not put food in my belly I am treated with kindness and love. Often a lovely basket of fruit and veg just arrives on my doorstep without my knowing who left it. My 57 years in medicine continues each day to give value over money. Hopefully Dr Jones will realise the deep meaning and value of compassion as his has been replaced by a scorn and disparagement.

    Dr. H. O'Connor

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  163. To those of you who are just now discovering my open letter to Dr. Jones, be advised that I posted this over two years ago. In other words, you are late to the discussion. If you are not going to take the time to read through the comments that the letter generated and my replies, don't bother trying to post a comment of your own, because I won't publish it.

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  164. Yeah, Craig. I caught the date. It's just that I had never heard of either of you until tonight.

    Gotta say, though ... nothing in his original letter struck me as racist. It's all about personal responsibility.

    There are a lot of luxuries that I would like to enjoy, but I recognize that I first need to invest my money in paying for necessities including (among other things) a home and healthcare (i.e., insurance premiums as well as co-pays & uncovered expenses).

    There are no gold teeth in my mouth (just some fillings). No tattoos on my skin. I still use the same cell phone I bought in four years ago, and I still drive the same vehicle I bought from a used car dealer 10 years ago.

    I have been helped by some government programs such as the Pell grants & subsidized loans that paid for my education. I simply didn't make it a way of life, and have paid back far more than I ever received.

    With any luck, the patient that Dr. Jones treated will make the same journey.

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  165. Who is to say that this patient's Medicaid status has been or will be a "way of life"? Like him, you are judging her based upon her appearance. The difference is, Dr. Jones is a physician. I hold him (as I do myself) to a higher standard.

    "May I merit to see in the sufferer who seeks my advice a person, neither rich or poor, friend or foe, good man or bad. When I see a man in distress let me see only a human being."

    Maimonides (1135-1204)

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  166. FYI This is my blog, not a discussion forum. When I posted my open letter to Dr. Jones in March of 2010, I also posted all of the responses, both favorable and otherwise. But at this point, unless you have something original to contribute, I am not going to post it.

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  167. As a physician myself, I find your initial assertion puzzling. Of course you yourself also pass judgement on your patients. You judge if they drink too much alcohol relative to their health conditions and assess their dietary need for change. If they smoke, you tell them to stop (I hope) and don't simply treat them and tell them 'Have a nice day'. That would be a disservice. So, of course you are judging people. While you and I dress it up in erudite verbage, it is a summation of our view on how they're living they're life. You tie it to their health and therefore it is noble of you to judge. Dr. Jones was tying it to fiscal policy, so somehow he is out of line? He did not mention race. Your leap, as mentioned by other posts, would hint at your own bias in that area.

    I worked ER for 5 years to get out of medical school debt in addition to my regular work hours. These efforts, and others, were preyed upon by unscrupulous administrators through various lies to cheat me out of earnings. I pay top dollar everywhere because I'm a doctor. I paid off my medical school debt with interest through long hours--mommy or daddy wasn't a doctor and no trust fund here. I've walked the walk. Dr. Jones sees tremendous waste in his work--I've walked in his shoes a few miles.

    There is vast abuse in the system. I see it, inpatient and outpatient. Patients dripping in leather, expensive toys, jewelry, driving nice vehicles, taking trips, with more deluxe cell phones than I...on Medicaid (all examples from WHITE patients, so you don't label me a racist). His point isn't that they're careless; they are actually quite full of care and thoughtful in their abuse. They know very well what they're doing and how they're manipulating the system. In generations past, it used to be people would starve before risking perceived shame of a 'handout'--they would require the opportunity to work off the debt or service in some symbolic fashion.

    (cont'd)
    Dr. Phillip Jansen

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  168. Herein lies the crucial difference between you and he and why ultimately you don't feel the passion or see the truth of his statements. He takes all comers. You have the benefit, in the vast majority of cases, of expert triage by your esteemed colleagues. How lucky for you. It is not allowed to turn patients away at ER registration. Ironically, despite this benefit, my highly Boarded self has been on the receiving end of abuse by well-compensated cardiologists when I dared interrupt their call day at home with a brief, well-summarized call while I'm trudging through a shift with for much less pay. You get FAR fewer people wasting your time with silly complaints. The issues he sees are those that should, by any estimation, be handled during day hours--that might require a co-pay and an appointment and a wait for said appointment. No, instead, they (blacks and whites), abuse the system by going to Emergency Rooms, making it more difficult for those who really need emergency assessment to receive care. Their threshold for going to the ER is far lower than mine or many others who have to consider whether the cost is worth the service/convenience. Besides, as mentioned above, they might receive 7 minutes of attention and a $1500 bill--this shortchanging does unfortunately occur.

    Dr. Jones likely gets paid by the hour. He doesn't submit exorbitant charges for spending 15 minutes reading an echocardiogram. He doesn't get to rake in massive profits from stress testing labs; I'm quite sure you're aware of the 2011 JAMA article showing that cardiologists that own the equipment as well as bill for professinal services order more post-revascularization stress tests than do cardiologists merely providing the professional services. So please save your holier than thou pronouncements. Your specialty is gouging the system. I challenge you to walk with me and tackle four complaints (e.g. fatigue, neuropathy, shortness of breath, joint aches) in a visit with Medicare's paltry reimbursement routinely, for if you don't you risk the ire of a patient complaint and having to deal with that from your employer, since you are beholden to employment due to weak reimbursement, poor payment, and lack of high-dollar procedures/billing schedules. No, because of the massive revenues your existence generates, in the hospital and out, hospital administrators usually humor most every whim cardiologists might have and cardiologists typically own/operate their own practice with autonomy. I beg your pardon, but I don't think you get to sit on judgement on Dr. Jones. Your job is nowhere near as difficult mentally or logistically.

    I will cut Dr. Jones some slack, sir, and I suggest you do the same, for he was not making an errant assessment. There IS a "culture crisis" in this country. Your pride might keep you from conceding the error in your initial response, but the vast majority of comments above underscores it. You missed his point or simply refuse to acknowledge it. You live an entirely different existence than Dr. Jones so don't presume to lecture him...or me. I really don't judge you too harshly, though, for it takes tremendous humility and grace to say, "Backup, in looking at things from all sides, I would change my assessment...or at least modify it."

    Dr. Phillip Jansen

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  169. Actually my allowable charges as a cardiologist are determined by CMS. And our reimbursement has declined substantially over the past several years. We don't own our own imaging equipment. And we see patients regardless of their financial status, including those who are uninsured and arrive in the ER at 2am in cardiogenic shock.

    I objected (and still do) to Dr. Jones's dismissive use of the term "the careless" in reference to one of his patients, a fellow human being. And to argue that he did not deliberately portray her as an African American is absurd.

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  170. And Dr. Jansen, had you really wanted to be a cardiologist you could have sacrificed an additional four years of your life, as I did, to complete a fellowship. Then you could take STEMI call every other night as I do while maintaining a door-to-balloon time of less than ninety minutes. For some reason I don't see many FPs in the hospital at 2am.

    BTW, neither of my parents were physicians, and like most of my colleagues I did not have a trust fund. I attended an in-state medical school and moonlighted during residency and fellowship.

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  171. Maybe Dr. Jansen should see a colleague about having that gigantic chip surgically removed from his shoulder.

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  172. Thank you for posting this, Dr. Siegel. My thoughts exactly.

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  173. I work in a small, rural hospital in up-state NY. We see people come into the ER with a runny nose, cough, tooth ache, etc. all the time. Most of them (African-American, Irish-American, German-American, etc.) are totally oblivious to the fact that the cost for this visit is much higher, than if they would go to the primary care clinic. They don't care. They come in, make demands for their meals, ask where they can go to smoke. It's disgusting. Something needs to be done. Able people are being supported by our taxes, yours and mine. I'm not OK with that.

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  174. I get that. There are those who abuse the system. But as physicians it is our duty to provide care for our fellow human beings, not to pass judgment on them as Dr. Jones has done.

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  175. You clearly missed the point. The things itemized by Dr. Jones, are expensive luxuries. He treated the patient. The items brought up, were merely to prove the point that if this person can afford all those luxuries, why the hell shouldn't they PAY for the own healthcare. I am certain, that patient received no less care and compassion, than any other patient. The fact that you have skewed his remarks into the ridiculous claim that he is passing judgment on the person, rather than a statement of fact to back up his opinion that the person can afford to pay for their own healthcare. I work very hard for my money, and I don't have a problem paying taxes to support government programs to assist people in need, However, where the problem lies, is the defining who is in NEED and who is sucking the life out of our country by shirking their responsibility to do everything in their power to fend for themselves. THAT IS EVERY PERSON'S responsibility, and I too am sick of watching the lazy and entitled take my money, that I work so hard to EARN.

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  176. Hopefully you will never find yourself in need of a safety net such as Medicaid. But if you do, I suggest that you leave any "expensive luxuries" such as cell phones and tennis shoes at home lest you be judged careless or lazy.

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  177. Dr. Siegel, THANK YOU for being the voice of sanity. Beautifully written.

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  178. Dr. Siegel, we need more of Dr's like you. Thank you. I so get what you are saying. As long as we expect the emergency room to take care of those who are uninsured, (didn't Mitt Romney have that plan?) our health care will remain in crisis. Most of us have known for years that we needed an overhaul to our health care system and most every political candidate for as far back as I can remember have mentioned it or attempted it. I give our President huge credit for getting it this far. Yes, it needs work, but at least he had the courage to start it. Many blessings to you .

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  179. J.S. Hubert M.D. FACSApril 18, 2013 at 5:14 PM

    It is not the place of a Doctor to form opinions of a patient and their possessions or lifestyle choices. (Other than Medical directly relating to the case.)

    As a retired surgeon, I am dismayed at Dr. Jones letter. He would be brought before the Hospital Board, in any institution I have ever word.

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  180. Very interesting discussion, I especially liked Rabbi Kari's objective statements about the costs of health insurance and the reasons why someone's appearance may not indicate their current financial status, etc. I agree that we should not be judging the people we care for. It is human nature to do so, but it is our responsibility as health care providers to provide the care, not judge the patient, their financial status, etc. It may be our responsibility to be both health care practitioners and responsible citizens of our country by participating in the process of electing our representatives and helping them make better decisions regarding health care funding to save money and encourage better health.

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  181. As the costs of health care skyrocket (and various studies deny it is 'lawyers' or 'insurance' or anything really? Really!) I have to wonder at nationalizing or single paying what has become social quicksand. Those doctors who do proctology with their heads might want to ask themselves why MDs are leaving their practices in great numbers "or" dropping out of insurance based "groups" and starting 'cash only' practices? Those who say "a doctor should not form an opinion" are lunatics... the very act of diagnosing 'is' an opinion founded in fact AS IS the opinion that many patients have not only 'brought themselves' to their pathetic state of health but ARE indeed expecting society to "pay for it!" Reprehensible behavior but no worse than Doctors who just march on towards extinction and an end to what has been the best medical system on the planet.

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  182. So what you are saying is that the sick have only themselves to blame and that the rest of us bear no responsibilty for them. How very Christian of you.

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  183. Bravo! To this real Doctor who takes pride in his profession that is built on ethics.I found this while researching on how this Dr.Jones could possibly be still practicing medicine after his outrageous unethical admission of his idea of patient care.I am a professional college educated author and I pay more personal property taxes than most make in a year however I am outraged by this Medical Doctor's outlook on humanity and would gladly finance his license to be revoked to ever practice any type of medicine again.

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  184. And before people attack my beliefs let me add that people like me make sizable donations every year to hospitals as well as other healthcare organizations all over the country just for them to keep operating but I will rethink my own personal donations after reading this Dr.Jones' letter.

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  185. That's very nice. More contributions on that order would be great. Between my mortgage, health ins premium for my family $1200/mo, auto, daughter's college fund, and more, I'm not much in the mood to finance other peoples needs. If they ask, I'll give, but no one is going to assume my money is up for discussion like I'm a ghost in the room

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  186. Your money, in the form of tax dollars, funds a wide range of government programs, many (if not most) of which actually benefit you either directly or indirectly. As for financing "other people's needs", I personally would not want to live in a society that did not provide a safety net for those less fortunate.

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