Luke Messac
@LukeMessac
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emergency physician, author of Your Money or Your Life: Debt Collection in American Medicine. Opinions my own. attending @BrighamWomens , @harvardmed
Providence, RI
Joined March 2018
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Your Money or Your Life: Debt Collection in American Medicine (coming November 1) is available for pre-order, with a discount code (AAFLYG6) for 30% off. You can also access the discount with the QR code below.
It's filled with reasons for rage and reasons for hope.
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13 years ago, I emailed Dr. Fauci out of the blue to ask if I might interview him for my undergrad thesis. He invited me to his office, where he answered all my questions. When I sent him the thesis, HE READ THE WHOLE THING (see his overly effusive review below). Who does that?!
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A nonprofit hospital chain paid McKinsey $45 million to help them prevent low-income patients from learning about charity care the hospital was legally required to provide. Employees repeatedly demanded payment while patients lay on gurneys in the ED.
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When I was 14, I was leading off 3rd base when my friend at the plate hit a line drive that struck my chest. Moments later, my heart stopped. It's a rare and usually fatal event. My coach and a nurse in the stands immediately started CPR, and saved my life. You can do it, too!
Hi, ER Doc here.
Did you know that bystander CPR can double or triple the chances of survival from cardiac arrest? This is how it works.
Life is precious. Learn CPR.
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In Pumping Iron, Schwarzenegger explained he would figure out what to work out every day by looking in a mirror and finding his weakest muscles. It’s pretty good advice for studying during residency. Every shift reveals a weakness, and greats never stop looking for their own.
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@newm161
Jesus raises Lazarus from dead in Book of John; "Lazarus effect" refers to AIDS pts after tx. In Book of Luke, Lazarus a beggar who dies at doorstep of rich man, who gave him nothing. Lazarus goes to heaven, rich man to Hades. I suggested 2nd story had relevance for the present.
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Great recruiting video for
@pnhp
. Single payer (aka
#MedicareForAll
) would end this insanity.
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That little pinch never felt so good! Y’all are up next! Can’t wait to see you get yours, so we can soon all be safe and together again.
#vaccination
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In 2017, a hospital in RI sued a patient for $1157 for an unpaid bill. Her response: “I can only afford to pay $5 a week…I am a single mother, with [a job]...and no state assistance.” She agreed to pay in full, in installments, over 4 yrs. Do we really need to sue poor patients?
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@SlimSmith5
Thx! Jesus raises Lazarus from dead in Book of John; "Lazarus effect" refers to AIDS pts after tx. In Book of Luke, Lazarus a beggar who dies at doorstep of rich man, who gave nothing. Lazarus goes to heaven, rich man to Hades. I suggested 2nd story had relevance for the present.
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@DrAelaf
Thanks, and yeah, gotta love Malawi. Obviously no pressure but if you do get the book be sure to use the discount code AAFLYG6 on the Oxford UP website so you don’t pay the ludicrous full cost.
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Great to see promising data on supervised opioid consumption in
@NEJM
. Europe, Canada and Australia have had these sites for decades, while in the US they’ve been forced underground. We need brave politicians willing to save lives by bringing safe consumption out of the shadows.
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At 18, John Lewis got a bus ticket to Montgomery from King. At 30, King accepted G. Ramachandran’s invitation to deepen his study of nonviolent resistance in India. At 17, Ramachandran became a student in Gandhi’s ashram. Let’s help each other “find a way to get in the way.”
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In
@NEJM
, I wrote a brief history of debt collection in medicine. In the last half-century, what was once a personal negotiation between doctor and patient transformed into an impersonal financial instrument, and aggressive collection tactics spread.
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There is often a poignant family history in a Malawian name. Lazarus Chakwera, the nation’s new president, was so named because his poor parents had lost 2 children in infancy, and thought this time the child must, like the biblical Lazarus, conquer death.
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Book contract signed with Oxford UP. Your Money or Your Life: Debt in American Medicine, a book about how medical debt collection came to be so aggressive, and what it is doing to us, will be out in fall 2023. A while from now, I know, but I’m excited for this.
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Thanks so much
@bekeh
and
@NewBooksAfrica
for this podcast interview on my book, No More to Spend. I really enjoyed the conversation. And check out Bekeh's great book, The Second Colonial Occupation, on the history of development planning in Nigeria!
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My Gram Nulty (aka Mary McNulty) died last week, at 99. Born in Nebraska, her family moved to Oregon during the Dust Bowl. When I was a kid, her farm was my favorite place in the world. Through her example, she taught me to be on time, save leftovers, and give whatever you have.
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A few months ago, staggered by the pain I saw in the ED, I finally read Victor Frankl. It helped: "Ultimately, man should not ask what the meaning of his life is, but rather must recognize that it is he who is asked. In a word, each man is questioned by life."
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One reason for the heartache many of us feel these days is that we've lost the idea that we rise or fall together. Solidarity helped people keep fighting through terrible crises, like WWII and AIDS. As Dr. Fauci said today, “The only way we end this is that we end it together.”
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Got that 2nd shot today! This is our ticket back to the people we love. Gonna be keeping up with vaccination stats like I used to follow the Red Sox in the AL East standings as a kid. Until we get there, you know where to find me.
#PeoplesVaccine
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Our beloved grandpa died today, without us by his side, of COVID. Born in Miragoane, Haiti in 1922, he taught hundreds at a school he led. After angering Duvalier, he settled in Boston. He wrote a beautiful (still unpublished) book of reflections on the Bible. It brims with hope.
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The impossible dignity of this man.
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To the virologists who toiled for decades in (relative) obscurity, living on grad student stipends, writing papers that only your colleagues and mothers would read, spending sunny days in basement labs, thank you for the light at the end of this dark tunnel.
If you're looking for
#COVID19
heroes, Dr. Barney Graham is top of my list. He works with Tony Fauci at NIAID and created the Moderna vaccine. Pfizer basically copied Graham's novel mRNA concept, which had plenty of doubters until this month.
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After so much training my family gave up asking when I would be done, it finally happened. I just started as an attending physician at
@BWHEmergencyMed
. Looking forward to joining a great team. So grateful to my
@BrownEMRes
family for the lifelong friendships and memories.
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The cover is out! Your Money or Your Life will be published in October. It is a history of hospitals' transformation from almshouses for the poor into aggressive collectors of medical debt. The story is even seedier than you think. You can preorder here:
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Reading
@jackmjenkins
American Prophets: Leading nuns provided crucial support for the ACA in 2010, while Catholic bishops stood in opposition. Later, the Vatican chastised nuns for challenging “the church’s authentic teachers of faith and morals.” Gotta love those Sisters.
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@EleniGiokos
Don't think so, but Krishna Prabhu and I coauthored a shorter, more readable chapter that covers some of the same history and arguments in a volume called Reimagining Global Health: An Introduction (eds. Farmer, Kim, Kleinman, Basilico, 2013). Royalties go to
@PIH
.
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My book, No More to Spend: Neglect and the Construction of Scarcity in Malawi’s History of Health Care, is coming out from Oxford University Press in March, and is now available for pre-order! …
So what's it about? A thread:
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If the
@AmerMedicalAssn
is really committed to fighting structural racism it will, at long last, end its century of opposition to single payer, and stop standing in the way of one of the biggest steps we could take toward ending health disparities.
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A story for any premed who has ever been warned that activism might affect your career. It might, but do it anyway. From the NYT obit of Jack Geiger, a giant in social medicine and a founder of the U.S. community health center movement; the clinics now serve 28 million patients.
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Before sickle cell took his life, my cousin Jon shared this poem about his experience of a pain crisis. New gene therapies with the potential to cure sickle cell will likely be approved in the next year. Ensuring universal access will be a civil rights struggle for our time.
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We should make sure our kids know about Roger Williams’ life and work. When MA Puritans insisted Native Americans were immoral and had indecipherable languages, Williams replied with a language primer on Narragansett and chronicle of their generosity.
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I have seen the ravages caused by rubber bullets, including ruptured eyeballs and brain damage.
@GovRaimondo
and other governors should heed the call of Physicians for Human Rights to ban the use of this colonial-era ammo against unarmed civilians.
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So glad to see the book reach
#1
as a new release in public health on Amazon. Can’t wait to see it in print in a few months. In the meantime, follow some of the groups doing great work to end medical debt at
@Dollarfor_
@StrikeDebt
@RightCareNow
and
@PNHP
!
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So many in public health are trained to argue over how to divvy up the existing scarce pool of vaccines. So few are prepared to explain how to rapidly increase production so we don’t have to do this who lives and who dies thing anymore. More of those folks, please.
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Paul Farmer,
@agnesbinagwaho
and
@IshaanKDesai
outline specific steps for increasing vaccine production in Africa. For example,
@pfizer
,
@moderna_tx
&
@BioNTech_Group
can help train personnel from African manufacturers in the new
@WHO
tech transfer hub.
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So proud of my little brother, who pushed his old junior high to stop honoring proponents of slavery like John C Calhoun and Henry Clay in the names of its hallways. He then went further, calling for a root-and-branch examination of racism in education.
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What share of US hospitals have policies that include legal action against patients over medical debt? (Tough question; they don't advertise the answer).
@NoamLevey
@KalataMegan
and a team worked for a year to find out. The answer? More than 2/3.
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For real, for real. I feel like I’ve heard far more calls from US academics for “decolonization” in reference to authorship than to, you know, the deadly colonial-era political economy we are seeing with vaccines right now.
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I’ve had a lot of older patients who live at home alone tell me how lonely they are these days. I’m sad to say I don’t know of many resources for them. Even worse, I don’t usually have time to lend a sympathetic ear during hectic ED shifts.
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In '08 I was an Obama campaign field organizer in Laurens County, one of the most Republican counties on this list. We registered thousands of new voters, and had so much fun. Would be oh-so-sweet if our hard-working friends there helped put Biden over the top.
Here’s the outstanding votes in Georgia, by county (from the SOS’s office):
Clayton 5726
Cobb 700
Floyd 444
Forsyth 4713
Gwinnett 4800
Laurens 1797
Taylor 456
Total 18,936
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Awesome. This will keep more rural hospitals open, prevent patients from going bankrupt and, most importantly, save lives. So great to have some good news, and reason to keep faith in the power of the people. Congrats to all who organized to make this happen.
I've seen enough: Missouri voters narrowly pass constitutional Amendment 2 to expand Medicaid.
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Frederick Douglass remembering Abraham Lincoln at 1876 unveiling of the D.C. Emancipation Memorial: "Our faith in him was often taxed and strained to the uttermost, but it never failed."
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"And now these three remain: faith, hope and love. But the greatest of these is love."
--The Good Book
Comfort and joy, y'all.
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My friend since freshman yr: "As we were vulnerable with each other, we drew strength from each other. We created our own curriculum. We laughed; held each other up; and affirmed our stories in tender, compassionate ways. The joy of community emerged from painful experiences."
My Annals article is about the discrimination we face as providers of color. My hope is that by sharing this pain, by showing how we’ve turned it into passion for our work and for each other, there will be no more silent suffering for trainees of color.
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It has always been a dream of mine to write in
@thenation
. Today I have a piece on the demise of the physician as independent professional, and how other health care workers show the way forward.
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I’ll be in New Haven on Wednesday (11/29) at 4PM EST with
@lindseymuniak
of
@StrikeDebt
and
@gregggonsalves
to talk about medical debt and the people organizing to end it. Come in person or watch from home.
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Worked on Obama campaign in rural GA in ‘08, where our task was to help register the 600k unregistered black folks in the state. Often when we turned in forms, county registrars tried to throw them out. If not for our lawyers they would have succeeded. The struggle continues.
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2 quick tips:
1) If you ever share a taxi with Dr. Paul Farmer, be warned: he will make sure you both empty your wallets for the tip.
2) If you can make it to his book launch on Wednesday, sign up! I've read the book. It will destroy you, in the best way possible.
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Gina Siddiqui just wrote the most honest, haunting and stubbornly hopeful piece on the ER I have ever read. Time to move beyond the pilot phase of effective programs that actually accompany patients outside the hospital.
@zaberdasst
via
@NYTimes
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This is so legit
I interviewed Tony Fauci yesterday for 45 mins. We geeked-out about how
#COVID19
is transmitted, but also how Trump is no longer getting the best advice. If you’ve got the attention span it’s a very different conversation than ones he usually has.
…
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For the best in vaccination campaigns, check out Navajo Nation, where the sense of collective responsibility for protecting one another and the determination to reach everyone, everywhere show the way for the rest of us.
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Incredible photojournalist and nurse
@alexkpotter
captures the transition between the ED and home, the sanctuary of the drive after work, highlighting the experiences of my teachers and colleagues, the nurses at
@RIHospital
.
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In 1998, a hospital in Maine publicized a program for poor uninsured patients to pay off out-of-pocket bills with hospital labor. One woman worked 20 hrs/wk for 4 months to settle a debt for gallbladder surgery. Anyone ever heard of this happening in any other American hospital?
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Vaccine hesitancy is centuries old, and history carries lessons. In
@projo
oped,
@meganranney
and I lay out keys to acceptance: 1) officials must show both care and competence; 2) actions speak louder; 3) don't sugarcoat the danger of the disease itself.
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Good. Now ban lawsuits, seizures of bank accounts, foreclosures, property liens, denial of care, wage garnishments, and arrests (body attachments) for medical debt.
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“All we need is the courage to act, and the time is now.” So pumped to fight for a Rhode Island with
#MedicareForAll
, a clean energy economy, better schools and affordable housing with
@mattbrownforgov
and this amazing crew of fellow volunteers. Join us!
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Thanks to
@PesteMagazine
for publishing this excerpt from my book, Your Money or Your Life, due out next year. It comes from a chapter on the rise of the medical debt buying industry. Read the other pieces in the magazine, a truly essential publication by an incredible crew.
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I support the inspiring efforts of
@MGBUnited
. The last three years have demonstrated, if we didn’t know it already, that resident physicians need a more powerful voice, particularly in times of crisis. To explain, I'll dig up some painful memories from 2020:
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As a black physician, I will speak uncomfortable truths about a system of law enforcement and a society that commit violence against black people. George Floyd, Stephon Clark, Breonna Taylor, Walter Scott, Tamir Rice...you are not forgotten. Grateful for allies like
@cmatulisMD
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I was today years old when I learned Christopher Lloyd (Doc Brown) was 47 years old when he made the first Back to the Future.
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Saving lives and protecting the economy are correlates, not competing priorities. Lessons from Finland and the rest of the EU in
@FT
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NYT reports Netanyahu admin is comparing civilian casualties it envisions in its own campaign to Hiroshima & Nagasaki:
Call your Reps and Senators, ask to speak to the legislative assistant for foreign affairs, and ask for a
#ceasefirenow
.
"It became evident to US officials" that Israel planned to turn Gaza into Hiroshima, leading those officials to express concerns
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The otherwise fantastic nurses at this ED in Sierra Leone keep saying things are “quiet” today, raising my blood pressure and showing not the least consideration for my American superstitions.
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My book, Your Money or Your Life, is coming out Nov 1. It would be so great to see you on the tour! All the events below are free and open to the public.
More dates and cities to come. You can register for the Nov 16 online event here:
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As a new doctor, I fear less for the patients I see than for those I don’t. Sick patients stay home, and sometimes die, because they can’t afford the bills that our cruel and inefficient system forces on them.
@mattbrownforgov
’s Medicare for All is the best plan for R.I., by far.
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Another legacy of the Roberts Court. Since 2012, when it allowed states to opt out of Medicaid expansion, lawmakers have used the power to show their resentment toward the poor. Now, lacking compensation for care of low-income patients, hospitals are at risk of closure.
"Mississippi currently has the nation’s highest poverty rate with some hospitals like Greenwood Leflore seeing up to 80 percent of their care going uncompensated."
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EDs and hospital wards desperately need more nurses. Without them, these dangerous waits will continue. America’s most trusted professionals should finally get the pay and benefits they deserve, and they shouldn’t have to travel to get them.
"We, a collective group of emergency physicians, are terrified for the future of healthcare in this state," the RI chapter of the American College of Emergency Physicians warned in a startling letter to the governor and state Health Department on Tuesday
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We use the technologies he invented (cardioversion and defibrillation) in the ED every day. Lown was brilliant. He was also courageous, risking his career to warn the world of the desolation nuclear war would bring. What a life.
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This
@curaffairspod
with
@astradisastra
,
@ebruenig
,
@sparkyabraham
&
@EliJMassey
on medical debt and solutions beyond charity is incredible. Reminded me how much more nurses have done than docs to take this on. Time to follow their lead.
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I wrote about the debate over charitable medical debt forgiveness drives, and how buying debt from collectors and hospitals risks perpetuating the injustice of medical debt.
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So awesome to see this policy. I still remember the shame I felt when I learned that my own town’s public schools were refusing to serve hot meals to kids with unpaid school lunch debts. May those days never return.
USDA extends universal free lunch through next school year, bringing relief to millions of food-insecure families
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After Obama '08, a Senate runoff in GA determined whether Dems would have a filibuster-proof majority. Dem Jim Martin lost because only 1/2 of his original voters showed up again. So much of the change we need requires the Senate. Let's win it this time:
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If you're in or around Cambridge, it would be great to see you on Wednesday evening (Nov 1) at 7PM at the Harvard Book Store. Let's make medicine a bit more just. With friend and role model
@s_keshavjee
.
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“Despite the overwhelming plea for change there has been no action, so our focus cannot be on basketball.” By sparking this strike, George Hill, Sterling Brown, and all the
@Bucks
players have given us the best highlight reel we’ll ever see.
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This MLK Day, go back to the source. Here's a passage from his last book, Where Do We Go From Here? Chaos or Community. King wrote it in Jamaica in 1967, as he prepared to lose much of his elite support for his opposition to the Vietnam War and his demands for economic justice.
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We’re seeing delayed presentations of emergencies (e.g. appendicitis, heart attacks, urinary tract obstruction). In the RI Med J,
@AnitaKnopov
, Meredith Horton & I discuss this life-threatening sequela of
#COVID19
. If you have an emergency, come to the ED!
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Stoked that
@jeaninecalkin
, one of Rhode Island’s strongest advocates for Medicare for All, just won the democratic primary in our state Senate district. Congrats!
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Strange that articles like this don’t mention the fact that 9 million Americans have lost health insurance, and far more have lost income, during the crisis. While fear of COVID may keep many ppl from seeking needed care, couldn’t fear of hospital bills be a factor here?
The steep reduction in patients coming to the hospital with heart attacks, strokes, and appendicitis is puzzling, even shocking, to many clinicians.
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Remember that sublime moment when a teacher handed you a syllabus filled with books and articles and films you had never heard of, but that you knew you'd wanted to experience for so, so long? That's the rush I've been chasing ever since.
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@meganranney
Oral rehydration therapy (literally a packet of salt and sugar dissolved in water) has saved the lives of over 50 million children in the fight against diarrheal diseases since the 1970s.
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Thanks
@projo
for publishing this op-ed about
#MedicareForAll
and the difference it would make for patients. Thanks
@SamuelWBell
@DawnEuer
@DonnaNesselbush
@anastatesenate2
@gaylegoldin
for calling for a more just and efficient system of health financing.
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“Medicare patients shouldn’t need a three-day hospital stay to qualify for rehabilitation. Patients who don’t require hospitalization, but can’t safely stay at home, should go directly to a nursing home.”
@LizGoldbergMD
speaks truth
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This paper is incredible. The authors use credit reports to chart the chronologic, geographic and demographic distribution of medical debt in the US. The map showing the concentration of debt in the South is a real eye-opener.
2. Medical debt is disproportionately concentrated in the South and in low-income communities. The avg amount of medical debt is 3x higher in the South than in the Northeast (left). The avg amount of medical debt is 5x higher in poor communities than rich ones (right).
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My brother’s 6th grade students in Oakland are pushing for justice by uncovering the history and health effects of a policy banning diesel burning large trucks along the 580, which runs near wealthier neighborhoods, but not the 880, where they live.
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This Thursday, November 16th, at 6:30PM EST, author and activist Kenyon Farrow and I will be talking medical debt and racial justice. You can register at link below. Event is free, with voluntary donation to Haymarket for hosting. Let's do this together.
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“Researchers and clinicians must distinguish between the use of race in descriptive statistics, where it plays a vital role in epidemiologic analyses, and in prescriptive clinical guidelines, where it can exacerbate inequities.”
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Pretty incredible rise in the percentage of doctors employed by hospital systems or corporate entities (such as private equity and insurance companies) in recent years, now up to 74%. The image of physicians as independent professionals is fading fast. Source:
@physadvocacy
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Full of hope to see that in the new year, a few cities are wiping out medical debts of residents. The first step toward a nation without medical debt. Next step to prevent debt from regrowing: national health insurance without significant cost-sharing.
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This, written by a friend I met at 18, is a reminder of what we thought medicine could be, when we started.
In this long season of loss, this is surely a triumph. My patient Jim means the world to me, so I wrote about our relationship, rooted in poetry, for The New Yorker. I’m so happy to share this with the world. For Jim.
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Um, this Dolly Parton doc on Netflix is...incredible. And Tenet is gonna demand a Reddit deep dive, I got so lost.
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Awesome piece by
@RanuDhillon
@AbraarKaran
@sri_srikrishna
. Hi-fi mask distribution for all! Better protection is key, especially now, with the virus so widespread, and more transmissible variants on the loose.
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