NYT Helps in Typical Rape-victim Smearing

We should have predicted this when we discussed the UVa Rape story in Rolling Stone last week, it was just a matter of time before people would start suggesting the central figure in the story, Jackie, might be fabricating. I would be surprised if this response did not occur, because sadly it is so typical. What I’m surprised by is that the New York Times, is credulously repeating this smear led by Richard Bradley, and Jonah Goldberg of all people.

Still, some journalists have raised questions about the story. Richard Bradley, who as an editor at George magazine was duped by the former New Republic writer and fabulist Stephen Glass, said in an essay that he had since learned to be skeptical of articles that confirm existing public narratives. “This story contains a lot of apocryphal tropes,” he wrote. Others, including Jonah Goldberg, a Los Angeles Times columnist, compared the case to rape accusations in 2006 against three lacrosse players at Duke University who were subsequently cleared and speculated that the Virginia story might be a hoax.

First, I’ll give you Richard Bradley might be legitimate, but his argument is completely speculative. He says it merely sounds odd to him. Hardly newsworthy. But then Jonah Goldberg? Author of “Liberal Fascism”? Who gives a damn what he thinks about anything? On the basis of basically one credible reporter’s feeling, they feel this deserves an article suggesting Jackie was not a credible source. Not on any independent investigation, sourcing or facts, they’re smearing this victim. And their argument about Rolling Stone’s reporting being adequate is highly debatable.

The subject of the article, who was identified by only her first name, had requested that her assailants not be contacted, and Rolling Stone decided that her situation was too delicate to risk going against her wishes, according to people familiar with the reporting process who declined to be identified because they were not authorized to speak publicly.
News media critics questioned the article’s reliance on a single source. “For the sake of Rolling Stone’s reputation,” said Erik Wemple, The Washington Post’s media critic, “Sabrina Rubin Erdely had better be the country’s greatest judge of character.”

So, the story should be rejected because they didn’t contact the rapist for his take on the story? Let’s predict how that would go. The guy would either say, “no comment”, “it never happened”, “I don’t know what you’re talking about”, or “talk to my lawyer.” If he was stupid he would admit some culpability or suggest it was consensual, thereby giving a future prosecutor an edge in establishing the fact of the crime. There, I filled in the blanks. Do they really think that would add anything to this story, or result in it not being reported? This is total nonsense.
Worse, it ignores the focus of the story, which isn’t about the facts of the victims allegations but in how my Alma Mater handles such allegations which is clearly sourced from discussions with several school administrators including the president Teresa Sullivan.
Can we call this anything but typical victim smearing? How dare the New York Times thoughtlessly promote this unethical critique of Rolling Stones reporting and this rape victim. This isn’t based on independent investigation, sourcing or facts, but on the feeling of one reporter, the reliable victim-bashing of a right-wing ideologue, and a misplaced argument about the value of obtaining “balance” by talking to an alleged rapist who (if he was smart) would undoubtedly be completely unhelpful or silent.
The point of Rolling Stone’s article was not to investigate a gang rape, but to expose how this University (and other universities as we discussed) similarly use internal rape boards to sweep crimes like these under the rug and avoid Clery Act reporting. NYT does a disservice to this victim, and other victims, by smearing Rolling Stone and Jackie in this fashion, without any real independent investigation or reporting. Maybe it’s time we write a letter to their ombudsman. I suggest you join me. Write to their public editor Margaret Sullivan at public@nytimes.com.
Also in today’s New York Times, another Cosby victim has come forward alleging sexual molestation when she was a minor. It strikes me as ironic, that this type of casual smearing of victims is the exact problem that allows serial rapists to thrive. Until we support victims, and stop reflexively accusing them of making rape allegations up, men who rape will have no problem moving from victim to victim without fear of justice.

Choosing a medical specialty

It’s that time of year, 4th year medical students (like me – kind of) are choosing their future careers and starting to interview all over the country in their residency programs of choice. I’ve been notably quiet – subsumed in work, study and applications – but I am catching up on writing about the clerkships I’ve done in the meantime (Pediatrics, Psych, OB/Gyn and Family Medicine). But since I’m applying for residency now (MD/PhDs have an abbreviated 4th year) I figured now would be a good time to tell people about what this is like, and in the coming months what cities I’m going to be in from time to time.

Choosing a medical specialty is a big decision. I’ve necessarily made up my mind, am very confident I’ve made the right choice and encourage you to take bets on my choice – it will be fun to see what people think. But the decision making process is famously difficult and many different strategies have been devised to help the indecisive (not me). Perhaps most famous is this chart first published in the BMJ by then-resident Boris Veysman:

If you’re very patient you can answer 130 redundant questions at this site offered by UVA to help you make up your mind, or read one of the books on the subject.

Then there is the famous Goo index, which I think may be quite useful. Basically, chose your specialty based on which types of bodily fluid you can stand being in contact with every day for the rest of your life. If you have a low tolerance for any goo, psychiatry or neurology might be up your alley. If you can take any fluid being sprayed at you at high velocity, surgery may be an excellent specialty for you.

Then there is the general opinion among the goo-heavy specialties that you should avoid the goo you dislike the most. For instance, if snot is bothersome, avoid pulmonary specialties and pediatrics. If it’s urine, maybe you shouldn’t go into urology (or if you don’t want to stare at genitalia all day). If you don’t mind blood but don’t like any of the stinky stuff, maybe neurosurgery is the right match. It’s all about balancing your goo exposure.

If you don’t want to get divorced during residency, maybe read this paper. The surprising result? Psychiatry is the worst at a 50% cumulative divorce rate followed by surgery at 33%, and most other medical specialties between 22-30%. I guess psychiatrists drive their spouses nuts when they bring their work home.

There is the Myers-Briggs guide to specialties which is only useful if you’re the type of person that likes astrology or other advice based on vague, general descriptions of people coached in psuedoscientific drivel. There is a lot of study of personality traits specific to different specialties, a review of the subject concludes that for the most part medical students tend to be too homogeneous for the blunt-instrument personality tests to distinguish something so specific as an ideal career choice and there is more variation of personalities within a given field than between fields.

So, using these highly-scientific and time-tested methodologies, which kind of medicine would you like to practice? Which do you think I chose?

A pregnancy boom at a Massachusetts high school

Surprisingly, it’s not due to the horribly misguided abstinence education nonsense. In fact, I can’t even begin to wrap my mind around this one.

As summer vacation begins, 17 girls at Gloucester High School are expecting babies–more than four times the number of pregnancies the 1,200-student school had last year. Some adults dismissed the statistic as a blip. Others blamed hit movies like Juno and Knocked Up for glamorizing young unwed mothers. But principal Joseph Sullivan knows at least part of the reason there’s been such a spike in teen pregnancies in this Massachusetts fishing town. School officials started looking into the matter as early as October after an unusual number of girls began filing into the school clinic to find out if they were pregnant. By May, several students had returned multiple times to get pregnancy tests, and on hearing the results, “some girls seemed more upset when they weren’t pregnant than when they were,” Sullivan says. All it took was a few simple questions before nearly half the expecting students, none older than 16, confessed to making a pact to get pregnant and raise their babies together. Then the story got worse. “We found out one of the fathers is a 24-year-old homeless guy,” the principal says, shaking his head.

Really? Assuming this isn’t some bizarre error of mis-reporting, this is clearly not a failure of contraception, but what I can only assume is a failure of our culture. Here’s why:

Continue reading “A pregnancy boom at a Massachusetts high school”

2 weeks of General Medicine

I’m sorry I’ve been buried the last couple weeks, as I’ve just started my general medicine rotation. Today is my post-call day, which means I get to sleep in and then study all day long. The fire hydrant of information is cranked open full bore again, and the shelf exam for medicine is supposed to the hardest. There is an incredible amount to know, and only a limited amount of time to assimilate it.

Inpatient medicine is especially challenging. It’s funny because most people’s perception of medicine is from all the TV shows about medicine and you see doctors constantly fixing some patient’s problem and then they get better. If I had to pick one thing to change about the fictitious practice of medicine it would be this idea that people ever have a single problem. The more realistic medicine patient would be someone over the age of 50 with at least 5 or 6 chronic problems, and just one (or two, or three) that has put them over the edge requiring hospitalization. It’s not about solving the medical mystery of the one thing wrong with your patient, it’s about first stabilizing people who are very ill and then figuring out why someone who already has half a dozen things wrong is suddenly getting worse.

Let’s do some recaps of fake medicine versus real medicine for fun. Let’s start with a good House patient (spoilers abound):
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Open letter to the People of the great state of Florida

Dear Floridians,

Greetings, and an early “hello”! I’m heading your way at the end of the week to spend my tourist dollars, and I can’t wait to see you!

But first, some important business.

Your representatives in the Florida House have just passed a so-called academic freedom bill. I strongly recommend a deep suspicion on your part regarding this bit of planned government intrusion into your children’s academic future. It is up to you, through your elected Senators, to stop this misguided intrusion of politics into science. It would also be wise to reconsider those who voted “aye” when they come up for re-election. If you fail, the consequences could be more serious than you imagine.

First, let me give you a brief outsider’s view of some of the goings-on. When your governor, Charlie Crist, was asked if he “believed in” evolution, he responded, “I believe in a lot of things. We should have the freedom to have a good exchange of ideas.”

As far as I am aware, this great country has always allowed for “good exchange of ideas”. Also, evolution isn’t something one “believes” in. It is a cornerstone of science. If you are not a scientist and don’t know much about it, there is no shame in that. Just admit it and pick up a book (I’d personally start with anything by Stephen Jay Gould). It would be nice to see a state leader stand up and say, “We have always had, and always will have, the freedom to exchange ideas, in and out of school. This is irrelevant to the design of a science curriculum.”

This bill, which will hopefully die in the Senate, is a sham. It makes a mockery of science, education, and religion. It is simply a way to allow the teaching of religion in the science classroom. Despite the fact that no teachers have filed complaints about evolution education, the bill is designed to protect these non-existent complainants.

And, as one of your own representatives astutely pointed out:

Rep. Carl Domino, R-Jupiter, said the bill would lead teachers to present their personal opinions on evolution in the classroom.

Noting that some people believe the Holocaust never happened or 9/11 was an Israel-hatched plot, Domino said he doesn’t want fringe theories introduced in public schools. “There are a lot of strange things out there that I don’t want teachers teaching,” said Domino, who joined the Democrats in voting against the bill.

Gee, that’s refreshing. Good for you, Senator Domino, and good for your contituents for electing you.

I have to tell you quite honestly—from the perspective of someone in a scientific field, the whole issue looks really silly. Science is brutal…theories that cannot hold up to withering scrutiny do not survive, and scientists are always interested in being the one to discover something new, even if that “something new” is the proof that a theory is wrong. Science is self-regulating that way. Scientists don’t need laws to remind them to critique each other. The idea is laughable.

More personally, as a physician and educator of young physicians, I’d worry about anyone educated in a state where precious time was taken from science classes to teach fairy tales, even popular ones. That’s what social studies is for. I like social studies. I’d feel bad if an aspiring doctor had to take extra time on their own to learn biology because some misguided or coerced teacher was spending time including every imaginable pseudoscience in their lesson plans.

So, my southern friends, good luck. I respect your beliefs, and I respect your right to have a wonderful Sunday school class on Genesis. If fact, try the original Hebrew, or the English translation by Everett Fox; it’s quite interesting—especially in a religion class. In a biology class, it’s just odd.


Peter A. Lipson, M.D.

Finally Free

At long last I have finished my surgical requirements. After 12 weeks of nonstop surgery rotations, despite enjoying it thoroughly, I’m ready to try something else for a while. Or at least I’m looking forward to waking up at 6AM rather than 4AM for a few months. It seems like such a small difference, but it’s literally the difference between night and day. Especially during the winter, starting at 5 on the wards and finishing usually well after dark, you begin to wonder if you’ll see the sun again. Being able to walk into work when it’s actually light out is very appealing.

My traffic has, of course, slowed. But I’ve still been thinking about good topics to write about this whole time. At the end of most days I’ve just been passing out rather than taking the time to mock crankery. Now I think my schedule will be a little more amenable to extramural writing, I have a backlog of things to discuss, and the first thing we’re going to be dealing with is this polling-based nonsense about ignoring denialism I’ve been hearing about lately. I’ll also talk some more about the fun things I’ve done, and if various people can avoid getting their panties in a bunch over little old me, I might be able to relate some more amusing things about medical education.

Some skills in medicine are harder to teach

Teaching facts is easy. Medical students eat facts like Cheetos, and regurgitate them like…well, use your imagination. Ask them the details of the Krebs cycle, they deliver. Ask them the attachments of the extensor pollicis brevis, and they’re likely to describe the entire hand to you. Facts, and the learning of them, has traditionally been the focus of the first two years of medical school. The second two years deals with putting facts into action. Teaching medical students and residents is very different from being a school teacher, something with which I have first-hand knowledge and experience. Fetal doctors want to learn…they’re too scared not to. In general, give a med student a book, and she’ll read three, and write a paper before you see her again. But some things in medicine are harder to teach.

Medical education in America underwent a revolution at the beginning of the 20th century, when texts were written, schools formed, and methods standardized. Now, 20 some-odd years into the evidence-based medicine revolution, medical education is improving once again.

MarkH describes a method being tested to teach doctors to think under pressure. The big difference between this and the way these things have traditionally been done is that people are measuring them. They are forming hypotheses about learning and testing them. And it’s about damned time.

My current teaching responsibilities are primarily those of teaching nascent internists how to practice their profession. The facts are (usually) there, but the judgment is not. This is also a field ready for evidence-based evaluation, but some things really do require repetition and mentoring.

I supervise residents at an outpatient clinic. They see their own patients, and they see patients who either walk in or make appointments for immediate problems. Treating patients you know is one thing—treating a complete stranger is another.

Continue reading “Some skills in medicine are harder to teach”

War Games!

One of the problems with medical education is that while you are intellectually trained to deal with medical problems and emergencies, actual experience with how to respond to emergent clinical situations is difficult to teach and usually only comes with experience. Further, real clinical experts make medical decisions almost by reflex. You see this in medical school that while you as a medical student have to actively think about what is going on in any given situation, medical experts act more by pattern recognition and have an instant reflexive response to clinical situations. And how do you teach reflexes?

Here at UVA, Jeff Young, a trauma surgeon and researcher in clinical decision making has published on a new strategy of assessing and improving the response of doctors in training to high-risk medical situations. His strategy is rather than stressing cognitive experience, which much of medical school and resident training emphasizes, the goal is to build reflexive responses to critical situations. In an emergency, the ability to generate differential diagnoses and recall complex information is secondary to knowing how to acutely assess patients, resuscitate and stabilize them. Clinical experts do this without even thinking about it. Young’s goal is to train medical students, interns and residents by simulation of critical care situations so that when they end up involved in charge of a critical patient they will reflexively perform the correct actions to resuscitate and stabilize patients. After all, practice makes perfect.

The result is what Dr. Young calls “War Games” – simulations in which students and residents are drilled in their responses to medical emergencies. By putting students under some stress and making them think fast about critical care, reflexive responses to emergent situations are drilled into the subjects, and hopefully when the situations are encountered in real life they’ll know what to do without even thinking about it.

So enough talking about it. Here’s what one looks like – me being drilled by the chief resident on a patient presenting with hypotension.

You notice that rather than going for diagnosis the goal is to start with the basics. First you evaluate the airway, breathing, and circulatory status, resuscitate the patient as necessary, gain IV access, get basic vitals and check tests. Only after you’ve stabilized a patient should you start thinking about what the exact diagnosis is, whether you need to operate etc. It also emphasizes things you don’t necessarily learn in class, like the need to call the attending when some disaster has occurred. It seems like things like this should be obvious (they probably are to EMTs and paramedics), but the reality is that these kinds of practical skills are difficult to relate in a classroom setting. You also quickly realize that when you are under pressure, it’s completely different from all those sessions you remember from 2nd year where you sat around thinking about differential diagnosis with 5 other people in the room. I clearly screw up a few times during the simulation, but hey, that’s why I’m in training and why I appreciate these sessions.

This also demonstrates something I think we can appreciate about evidence-based medicine. Not only do we emphasize a scientific basis for the treatments we use, but we also actively use science to figure out the best ways to train doctors to be better clinicians. I found this strategy to be incredibly useful, and I hope other medical schools around the country also adopt War Games to help train their students to be better docs.

Things that suck about medical school

My least favorite thing? Being constantly ill. Of the eight weeks or so I’ve been back, I’ve been sick for about four of them. I managed to get by the first three or four weeks cold-free through neurotic hand-washing before the current cold circulating the hospital got a whack at me.

It was a pretty obnoxious cold and I still was just getting over it when I got hit by this second cold, a gift, I believe, from a friend working on a pediatrics rotation. This one actually floored me with a fever of over 101 and now I’m finally coming down below a hundred. And you know what the real pathetic thing is? I wish these things would hit me over the weekend so I don’t have to miss school.


I’ve almost come to the end of the core 8 weeks of my surgery rotation (4 more weeks follow in electives) and am currently working on the trauma service for another couple days before taking exams.

I don’t have a great deal to say, the hours stay long, the medicine remains interesting etc. I’m enjoying the decrease in laundry that wearing scrubs entails. I enjoy how much doctors tend to take joy in their work. Medicine is a great field that way, as it gives you a feeling of accomplishment as you see what you do day to day really can make a big difference in people’s lives. The debt may be overwhelming, the paperwork endless, and the insurance companies/health policy maddening, but you can see that the satisfaction from the practice of medicine gets them through all the hassles. I’m also amused by the tendency of my attendings to turn to me and say, “don’t blog about this” before saying something funny. Don’t worry guys, I won’t. I’ll just save it for my tell-all book.*

Trauma is an incredible field, and while I won’t comment on the workload (everyone on the trauma ward is a little superstitious – one never comments on things being slow or fast for fear things will become busy, or worse, crushingly busy) it has been an interesting couple of weeks. In particular, one of the attendings uses a unique teaching technique that I’ll write about later this week (with permission) using simulations that we refer to as War Games. I found it all very interesting and helpful so with luck we’ll have a video of me participating in one of these sessions by the end of the week. I’ll write a post on it then, as I hope it can be implemented more widely in medical education.

I’d also like to take this opportunity to ask a couple of favors.

One, I’d very much like people to stop shooting one another. It’s really terrible what bullets do to a body.

Two, it also might help if you all could wear helmets. If I thought you could avoid hitting your head that would be one thing, but the least you can do is take some precautions. Wear them a lot – riding bikes, motorcycles, skiing, etc. In fact, just wear them all the time. Sitting at your desk? Wear a helmet. Walking in the park? Wear a helmet. We’re going to start a new style right here and now. We’ll call it the “I’m either about to get on a bike or am prone to seizures” look.

It would make me feel better. Really.

* Kidding, kidding.