Saturday, August 16, 2014

On my life

It’s August 2014 and it’s been too long since I've written anything here. A lot has been happening in my life. I’m happy, but a lot has happened.

Woodworking. I’m still woodworking. Still loving it. The last thing I've made is to replicate a plastic step-stool I have (because I’m short) so I can have one in my workshop and one inside the house. I've slowed down from buying tools too, but I can’t guarantee how long that will last.

Lego. I’m moving the Lego from the spare bedroom to a large display cabinet I got for my living room. I was hesitant at first to put them in a “fixed” position such a display cabinet or shelf, but now I much prefer to have them within easy view from the couch.

Work. Work is fine, but sometimes things frustrate me. On slow days I get frustrated with the fact that if I don’t see patients then I don’t get paid. On busy days I get frustrated with scheduling issues. Often I get frustrated with certain patients’ expectations of special treatment. More often I get frustrated at myself for allowing these patients’ behaviour, things other doctors or professionals from any other industry would not allow. Most days though something or someone will remind me why I do my job in the first place, and then I am satisfied.

Family. Well, not so much family as religion. I am still very dissatisfied with the way the religious group I belong to operates. My mother has to remain distant from me in order for me to protect her. And yet the threat isn't me; I am the one that loves her! The threat is posed by the religious group we belong too. I will admit that after my last blog, somebody confused a post I made on my facebook with the post I made about the things I love in life and told my mother some very vicious and hurtful lies about what I post online (she, of course, does not even use the internet to check things out herself). This resulted in my mother telling me she has never felt more ashamed of me in her life, and she is embarrassed of me because of the things I post online. Ashamed of me, of her daughter! Regretful of the fact I was born and the way I am. Yes, of me, and it’s not the first time she’s ever said that to me. And yet I love her and I know that in reality she loves me, but those words are the result of the religious group we belong too. That is sad. And there is nothing I can do to change anything. I can only love my mother, accept that she hasn't yet realised what I have (that we belong to a cult), and keep going about my life.

The last month. Gosh, I don’t feel I own this story wholly so I will try to remain respectful of other’s privacy and intimacies. In this last month I have at times felt so alone, at other times it was the closest I've ever felt to any other human being, so intrinsically-linked, so unbelievably happy, and then so terribly disappointed and angry. And yet, somehow, and definitely helped along because I know I am not alone, I remain hopeful. I feel I have this undercurrent of general positivity. I am strong because I am not alone. I feel strong because I choose to remain positive and optimistic despite some hell of an emotional roller-coaster. I feel like a soldier, but not a soldier on their own, but one that is part of an army. My army, our army, and though we may not win every battle, we are not beaten. I am so not done.

Wednesday, May 28, 2014

On my obsessions

A dam koala... A koala I saw on a visit to a dam.
If you haven’t noticed, I haven’t been writing a lot recently – and I love writing! But turns out there are a lot of things I love also. Recently someone described it perhaps more correctly as obsessions; I get obsessed with certain things. Rewind back to a year ago and I was completely absorbed with guitars. I was obsessed with learning about them, taking them apart and modifying several, and even trying to learn to play. Well, I didn't quite get to the playing part due to having a mismatch in attitudes with my teacher who discouraged me to the point I now get panicked to even hold the guitars in my house, but that’s a story for another day. The list of other things I’m told I also obsess about are my Lego collection/village, rabbits (in all shapes and form), buying bed linen, and the one thing that has been consuming me day and night for the last month or two: woodworking.

My obsession with woodworking started from when I was a teenager, or perhaps even younger. See, I was always a nerdy kid, the kid who preferred going to the library at lunch time, and absolutely dreaded phys ed class. I wasn't good any activity that was physical, and I didn't enjoy it at all. I did, however, really enjoy visual and literary arts, and once I was introduced to it, I fell in love with manual arts too. Suddenly I enjoyed something that wasn't purely intellectual – and it didn't matter how good or bad you were, most things could be fixed somehow. I did manual arts for 3 years in high school, dropping it for the senior years to focus on the academic stuff. I remember I told my mum and siblings that one day I would become a doctor and I’d buy a house and in my house I’d have a workshop and then I would take up woodworking again.

Well, here I am. Coincidentally the house I bought happened to have this room at the back of the garage that, well, someone could turn into my workshop. And that’s what I've been doing. That’s what I do when I get home from work and on my days off. I recently took a 2 week holiday in which I think I spent 80% of my waking hours in that room. A large proportion of the remaining time was spent buying tools. And you know what? I had a great few weeks. It gave me a new focus and clarity to return to work and the rest of my life.

I read a woodworking blog once where someone asked, ‘what have you learnt from woodworking that also applies in general life?’ I made a light-hearted note recently when my router stopped working suddenly just as I was preparing to fix it to a table, that some things would rather die than lose their freedom. That was a joke, of course (for people like me), but a more memorable quote I once read said that a master woodworker isn't one who doesn't makes mistakes, but one who can cover up their mistakes well. And that’s more like my style of philosophy:  Everyone stuffs up; what matters is what you do next.

But, yes, the obsession part of this, as was pointed out to me, is I spend a lot of time buying tools, doing random odd jobs in my workshop, and watching, reading, and attending woodworking shows/magazines/videos. A LOT of time! My plants are going unwatered. I get itchy at work to go home and work on some unfinished project when I have gaps between seeing patients. I've had to re-calculate my budget to try to stop myself from overspending on tools and things for woodworking. I've been neglecting my own blog and reading so many woodworking blogs. It’s ironic, yet at the same time I think I’m finally learning about the importance of balance.  When my life isn't just work, it is so much more enjoyable.

Wednesday, April 9, 2014

On Lance Armstrong

It was only when I watched this report on "smart drugs" that I finally understood how skewed our perception of Lance Armstrong is. See, in the report this scientist speaks of how taking these types of drugs can make people be able to read quicker, maybe retain some of that knowledge, maybe be able to retrieve it quicker and more consistently than if you didn't take the drug. The theory goes that if you do these things with greater ease, then you’ll be able to perform better on tests that measure how "smart" you are, and maybe even other types of academic tests. That's why some college students find using these drugs of advantage for their studies. But I asked myself, can I take some of these drugs and then go and pass a test on astrophysics or mathematics or computer programming? Could I? Not unless I've at last read the subject matter before! And that's just it; I can't be "smart" unless I put in at least some effort myself. All the best drugs in the world can't make me pass a test on theoretical physics if I don't even know what theoretical physics is.

I know, that's not a real comparison though, right? I mean if I want to pass a test on a subject matter it's probably because I at least have some interest in this matter, have heard of it, and for some reason have decided that this is important to me. If I had had access to them in medical school, would I have taken "smart drugs"? Well, I could argue that I obviously didn't need to to graduate. But what would have happened if I did? I could have taken less time to study as I may have being able to read quicker, learn quicker, and recall more consistently. I could have, in turn, dedicated more time to leisure activities. Or, I could have studied some more and got even better grades (for what benefit I don't know, but that's a possibility). The real question is would it be unfair to other students if some take ‘performance-enhancing’ drugs and others didn't? Would this whole conversation be unnecessary if every student in the class had access to these drugs? Well, this is exactly what Lance Armstrong's logic was even when he did confess to using (banned) performance enhancing drugs and techniques in international professional cycling competitions. What he told himself was that if everyone does it, it's not cheating and it’s not wrong and it's not even worthy of discussion.

But let me go back to my original scenario about "smart drugs" in academia. No, they don't work on just nothing, and if you have never heard about thermodynamics, taking all the best performance-enhancing drugs in the world will not magically make you know about it. You still won't pass tests that other students who have studied know about. You have actually no advantage over them despite the drugs - unless the drugs are not the only thing at play.

Lance Armstrong. Everyone feels entitled to call him a cheat and a liar. He's a bad person, right? Well, firstly let me state my opinion – and yes, this is just opinion. Certainly (as he admits) he has done and said some things to cover up his use of performance-enhancing drugs and techniques that hurt other people. He broke international cycling competition rules also. He denied other competitors a right to an equal playing field. And he tarnished the reputation of a sport and competitions a lot of people had a high regard for. But more than that, I think what people (and I mean people outside of the cycling world especially) feel most upset by is the selling of a false story. I mean, he was thought of a hero and an example of overcoming great adversity for equally great success in life (overcoming metastatic testicular cancer) and what is a very difficult sport. His story gave many people hope, inspiration, and motivation. This is why Lance Armstrong was so widely respected and admired. But that story (perhaps) only occurred because he gave himself unfair advantages. He molded and manipulated the circumstances so that the story would unfold the way it did: with him as the winner. That part of it I feel we have a right to be upset about, but I think for the majority of us, that is where our opinion of him should end.

Lance Armstrong  is a very flawed character, and yet I think we all somehow forget that the majority of us weren't there on the race track on bikes competing next to him.  A lot of us act as if he personally cheated against one of us. A lot of us believe he had no right to the admiration and success he had because of his use of performance-enhancing techniques. But the truth is how many of us have cycled 3,400km in 21 days? I haven’t and I don’t know personally many people who do. Yet a lot more people that don’t do this either, behave with criticism towards Lance Armstrong as if they had been his immediate competitors in the Tour de France. We didn't compete because we weren't motivated to, we lacked the physical and mental stamina to undertake such a marathon task, we simply were not up to the standard required for it at all. And that’s the thing I realised when I watched the report on “smart drugs”, that no matter what anyone says, drugs do not work on nothing. Something of the whole Lance Armstrong story was the individual himself (was it the motivation, the will, the mental determination, the hours of physical training and preparation, etc - who knows?). and not purely the performance-enhancing techniques he utilised.

So I think, yes, admit that we are angry towards Lance Armstrong for selling us a false story, for giving us hope based on false premises, for acting erroneously towards a lot of individual and sporting groups – but remember, we were not his competitors and are not and should not judge him as being any more or any less than we are: an imperfect human being.

Sunday, March 23, 2014

On medicine and public money in Australia

Recently I was at a meeting organised by a community pharmacist to “remind” myself and other general practice doctors about a scheme available to patients that not only can help patients, but just also happens to be remunerated quite well by Australia’s federal health care system, Medicare. And I mean it pays general practitioners (GPs) well, and it pays pharmacists well. Suddenly another GP in the room asked just why are we being paid extra to do this when as GPs we have little to actually contribute to this patient’s particular health care encounter. The room fell silent. I couldn’t believe that finally someone had said what I had suspected for some time but didn’t have the courage to admit: that in some instances, the government does misspend money allocated for health care. I know, it seems so counterintuitive, so out of place, to suggest this at a time when the Australian government is saying that health care funding is becoming unsustainable, that the need for it has made it such a drain to government funds that it’s become unaffordable to fund alone on public money.

So where are the holes in the bucket with public health care funding? Well, in the interest of open disclosure I will admit that it’s been years since I worked in the public hospital system. I work in private practice, but as most doctors in private practice, still work under Medicare rules and (federal) funding. What I mean by this is, although we work in medical clinics that are privately owned, we receive Medicare money for part or all of the work we do. The choice to accept Medicare funding as the whole payment for services provided (i.e. “bulk-billing”) or only as part of the total fee is each practitioners choice. And the choice is not as simple as “some doctors are greedy and some aren't”.

I’m not a greedy person, but I refuse to accept the inadequately-low fees Medicare offers as payment for most general medical consultations. Let me explain this with a simple everyday example. Seeing a patient for a general medical complaint in a consulting room for 15 minutes costs the medical centre about $65-$71. That is what it’s going to cost to pay the doctor, administration staff, building running costs, etc. Now, Medicare Australia only pays $36.30 for this service. The federal government pays that not because they have calculated that that is what it actually costs for the medical centre to actually fund this consultation. No, this has been a federal budgeting decision that says that that is all the government is willing to pay for this service. It does not take into consideration the medical needs of the patient, the individual patient’s financial situation, and it certainly does not take into account the real costs of medical practice today. So, the government has essentially given the Australian public Medicare cards that you could roughly equate to “50% discount” cards (when used in private general medical practice), but they have unfortunately gone and told them that they are “100% discount” cards. And what’s more frustrating than patients not realising this, is that they expect this, politicians tell them they have a right to receive healthcare from private practitioners that are 100% subsidised (what is commonly called bulk-billing) using their 50% discount cards. What happens then is that medical centres have to charge individual patients the difference of what it actually costs to fund their healthcare and what the government is willing to pay on their behalf – or you go to a medical centre that has adjusted their practice not to suit the patient’s medical needs, but to try to make the smaller money from bulk-billing stretch (I won’t go into their practices, but there’s a reason I refuse to work in that system). But that’s not the story the governments tells the general public, honesty doesn't win votes, what they tell the public is that doctors are charging them more because they are greedy, not because governments are not funding their healthcare adequately.

Having said that, let me now discuss instances where I feel funds are not best justified. Some years ago, it was brought to the government’s attention that there is a high incidence of mental illness in the community. This affects a large proportion of people’s health, and ultimately it also becomes a drain on the social welfare system. It was identified that psychotherapy could help a lot of these patients with mental health problems. So it was then decided to allow Medicare to fund psychologist visits if it was deemed by a doctor that this was likely to benefit a person’s mental health. In order to encourage GPs to asses patient’s mental health and subsequently refer them to psychology services, Medicare offered substantial funding to GPs to provide this service. Considering the high incidence of mental illness, the cost of paying GPs and subsequently also funding psychology visits, this resulted in a massive new/extra expenditure for Medicare. So although the government wanted to encourage extra referrals to psychologists, they wanted to make sure that people weren't being unnecessarily referred who perhaps didn't require it. To ascertain this, Medicare introduced clauses that referring GPs had to obey, things like how long the consultation  must last, what must be covered in the consultation, what things had to be recorded in patient’s charts and in referring letters, etc. As time has passed, these things came to lose their function: most GPs could take less than 20 minutes (one of the initial clauses) to identify that a patient likely was suffering a mental illness that may benefit from psychotherapy and write a simple referral for this. In fact, I would argue that were it not for trying to meticulously (and unnecessarily?) follow all Medicare clauses, this could all be done in the course of a single standard medical consultation. Remove the clauses, respect doctor’s clinical judgement more, and get rid of special extra incentives to GPs. I know, I know, how dare I suggest a “pay-cut”? I’m not, really, all I’m suggesting is a redistribution of public funds within healthcare.

I could raise a similar argument about other general practice activities that are all clunked up with a lot of Medicare clauses, that pay a lot money (and I say this only comparatively to other general practice activities like consultations [which are underfunded]), and that could be just as well performed by doctors without either the extra clauses or the extra money. I mean things like home medication reviews where it is acceptable that pharmacist are paid for, but it is hard to justify why doctors should also receive an extra reimbursement when we are already expected to review patient’s medications as part of a normal consultation. A lot of people also seek ‘care plans’ to be eligible for some Medicare-funded allied health services. Why not just trust that GPs can make an assessment in a general consultation that a patient has a chronic illness and would benefit from allied health assistance? And while we’re on Medicare-subsidised allied health referrals, why is Medicare funding referral for therapies whose benefit’s on people’s health is not widely accepted and tested as beneficial? Medicare offers subsidised consults with osteopaths and chiropractors for patients with chronic illnesses (on a care plan) who have been referred by a GP. Why? Even some private health funds refuse to subsidise this (due to their unproved benefits) and the Australian government thinks it is worthwhile throwing precious health care dollars at it?!

To maintain my focus on what I have more personal experience with, I haven’t commented on how public health care money can be misdirected in public hospitals. However, you can speak to many public health employees in Queensland and they’ll all be able to tell you that a lot of public health care money is directed to bureaucrats and purely bureaucratic processes. Now, I will give you a simple example of how I have noted this happening more and more – even from my end as a private practitioner in the community.

Remember how one of the “perks” of private health insurance in Australia is said to be that the patient can nominate which specialist they are to see? Well, the opposite of this is that if you attend a public hospital, there is no choice given and people are triaged on clinical need, etc. as to which practitioner they see and in what relative time frame. Well, a few years ago I could refer a patient to a public hospital outpatient clinic for review with doctors of a particular specialty and exactly that happened: the patient received a letter to attend an appointment to the outpatient clinic of a particular specialty. Do you know what happens now? That when I send a referral for a patient to see a general surgeon, for example, in a few days’ time myself and the patient receive the first of a series of letters. This first one says this clinic is heavily booked, reconsider the referral, and go back to your GP to discuss this further (I tell patients to expect this letter and to ignore it). The second letter is just for me, and  it says that the patient has been given an appointment with a specialist (but they don’t state who) but because of Medicare rules, could I please tick the name of the specialist on the form, rewrite my referral, sign this new referral form, and then fax it back to them. But the patient already has an appointment booked with a particular specialist so that’s the specialist’s name I need to tick (I have to call them to ask them who this is before I can fax it back to them), and they obviously already know the clinical details I had on the original referral or the appointment would not have been booked. After I return the form to this hospital booking department, the third letter (and the only one that needed to be sent, really) arrives giving details of when the appointment is booked for. I ask myself why all this bureaucracy? And more importantly, which of my hospital colleagues in clinical roles lost their income so that this crazy bureaucracy  could be funded?

Sunday, March 16, 2014

On happiness (again)

I just found this quote again from The Zahir, one of my favourite books by Paulo Coelho: "No one should ever ask themselves that: why am I unhappy? The question carries within it the virus that will destroy everything. If we ask that question, it means we want to find out what makes us happy. If what makes us happy is different from what we have now, then we must either change once and for all or stay as we are, feeling even more unhappy."

I haven't been happy lately. I mean, I don't even know if I'm unhappy, miserable, or just expectant. And I thought to try to solve my question of whether I am happy or depressed or what by asking myself this: what would it take for me to be happy? Well, I always thought that I'd like to have a family unit of my own, to provide a house for them, to provide for my family, to work a job I don't hate, and to raise a child and be a good mother. But lately it's becoming tiresome having to get up in the morning and go to work. I want my work day to go quickly. I want tomorrow to take it's time getting here. I want the weekends to last forever. I want to stay in bed longer, to eat more, and more time to sit and not interact with anyone.

I figure I'm not depressed as at least I still want something, even if they are avoidant things. I remember a time when I was depressed and I just wanted nothing at all, when nothing mattered at all. So at least I do want things now. But am I happy? Will I ever be happy? I think I want to be. Yet I remember another quote, another favourite of mine, and I remember why at the same time I want never to be fully happy. I've also quoted this, by Charles Becker, before: “I would urge that you be dissatisfied. Not dissatisfied in the sense of disgruntlement, but dissatisfied in the sense of that ‘divine discontent’ which throughout the history of the world has produced all real progress and reform. I hope you will never be satisfied. I hope you will constantly feel the urge to improve and perfect not only yourself, but also the world around you”.

Is that why I'm unhappy? Is it because I do always want to be progressive, someone who is always active and contributing? Or am I just depressed? Lately I've been thinking about the very real probability that I may actually have the chance to start my own family soon, and I am so wanting it, so contemplating it as a reality I want, that it's making the rest of my life seem tedious and just like a filler in time. And, oh God, the possibility of not having a family and a providing for them - that is pure misery! The thought of it can put me in tears and despair. Am I unhappy? Is this vision of "happiness" unattained slowly killing my spirit? Or is it something else? Sometimes I think the best way out of all the uncertainty that is weighing me down is to just ignore the questions and simply move forward.

And maybe it's not even forward that I need to go, but backward. That is to say that sometimes I think it's best I go back to simpler times; like the time I first learnt about positive and negative contingencies. Recently my pet rabbit became ill and I hadn't felt that miserable in such a long time. I was petrified she may die and was suffering. I wanted her so badly to be well again. She needed surgery and was at the vet hospital three nights. I worried endlessly about her. I thought that if she dies, my life will lose its centre of balance and I would be immensely sad. I cried at the thought of it. When I finally got to bring her home, she was still quite fragile and I was still worried, though not as much as previously. Then I remembered to set myself a positive contingency: as soon as she's eating, drinking, and pooing normally again, I will be happy as I will know she has recuperated. That happened a few days after she came home! And even though I was upset from other events in my life, I actually felt happiness again in my heart to see my little rabbit eating away at some food. Yes, such little things can make me happy if I allow them too. And it is also true, of course, that also little things can make me very unhappy if I allow them too. But for now, my rabbit is eating her hay, hopping around, and I am a happy woman again, moving forward :)

Sunday, March 9, 2014

On insight

When I was younger a psychologist once asked me why I always ended up in relationships with people who were 'unavailable'. Of course, she asked me this rhetorically to prompt me to reflect on the pattern of my relationships. She asked if I could remember the first time someone had made me feel like I was vying for their attention and yet I wasn't getting my emotional needs met consistently. Yes, how cliché, it was with my mother as a child! Now, what most people instinctively do when we find a source to our problems is it either 1) brings us comfort by allowing us to say "hey, it's not my fault I'm like this", or 2)  we feel guilty that we are the way we are. The problem with blaming the past, though, is it's of no use to anyone if it doesn't force change.

If we feel guilt (which is an unpleasant emotion and thus makes for a great self-flagellation device), we come to believe that feeling guilty is exoneration enough for doing what we do. But if feeling guilty is ALL we do, we usually just continue to behave in the emotionally-immature coping patterns we're used to. It's not enough to feel guilty. It's not enough to wait passively for things to change. In real life, the poor little victim princess doesn't magically get rescued by a hero. In real life the princess needs to build up her strength, overcome her own past, and slay her own dragons in order for things to change for her. It's not a matter of 'good things happen to those that wait', but rather good things happen to those who make things change.

Sunday, February 16, 2014

On punches

One thing that has really been irking me in the last few weeks is the negative stereotype that is getting peddled about the men who (accidentally) kill or seriously injure other men with one punch. I mean, I know, the media is telling us that it's only the other guy's story matters and the guy who threw the punch is a "coward", a monster, someone who should have known better. They call the punches that result in such grave injuries a "king hit", a "coward punch". Now, I believe, that had these punches not resulted in these grave injuries, they would have been called an "awesome hit", a "hero punch", a "champion move" or something positive like that. Why do I say that? Because the truth is so often we do glorify violence and displays of machismo like that. It's literally like that saying, 'it's all fun and games until someone gets hurt'.

Now is about the point where people tell me I've got it all wrong, that the men punching other men like this are thugs and demons and simply bad people. They're not people like us, they're different. You know, because the rest of us apparently don't delight in violence in movies, we don't cheer on contact competitive sports, and we haven't been responsible for making "ultimate fighting" so popular on television that we now want to enroll our children into mixed martial arts lessons so they can be the next cage-fighting champion. I know, I know, witnessing violence doesn't make people violent, right? Probably not, but the case is often that art imitates life and not the other way around. It's not that things magically appear on television and we want to do exactly like it; I think its more that television executives observe what the rest of us like and want to put that in television so we can relate and watch their shows (and buy advertised products, etc). Generally, we like to watch what we already like. But I digress... What I'm meaning to say is that the people punching other people are often regular people like us who make very poor decisions,and those decisions lead to poor consequences. These decisions themselves are often predisposed by (usually) alcohol and/or other drugs, peer pressure, and the other unique social pressures men in our society face.

I once heard a woman praising her child for having punched another boy in the abdomen. She was proud of him for having demanded his own respect via violence. She was proud of him because by his behaviour this boy had shown he was becoming a "man". And she was proud of him because  that other child was not her child. Now, this woman is an otherwise very well-intentioned human being and mother, but she has learnt to have the same expectations a lot of us have of how men ought to behave. Men do not sit down and talk about their indifferences, they should fight them out physically. Men should show their superiority and demand their pride be respected by physical displays of strength. Men need to consume as much alcohol as their bodies will tolerate so they are not thought of as "wimps" by their peers. Men should be muscular. Muscular and strong men have a right to pick on less muscular and physically less-strong men. Men in the company of others must always seek to be seen to be the stronger one. These are the kind of pressures men face most days. Even the female partners of men often demand this behaviour of them. For example, how many of us have seen a man who disrespects another man's partner, and then this partner demands that he "be a man" and confront the other man (usually verbally, but with the expectation that use of physical violence is acceptable too). And that's just it, we've created a society where people are taught that violence sometimes is an option, and that option is higher up in the hierarchy of options if you're a man.

The reality is that a lot of us have felt angry at times - and a lot of us have wanted to react violently at times when we were angry. A lot of people have also faced the situation where they were so intoxicated that their usual inhibitions were lowered, where they're more susceptible to make bad choices. Hey, some of these people sometimes punch others too. I'd say more often than not, they are barely thinking of the potential consequences of their actions. I mean, these are normal people making bad choices that are tainted as the big bad demons when one of their punches cause another person a serious injury. There is no point in ruining their reputation either or calling them a coward. But here is where I do lay some blame on the media.

The media knows what we like, what human beings are used to and expect. And we all love stories of villains and victims, of good guys and bad guys, of heroes and cowards. So that is what the media feeds us: a poor young innocent man being a model citizen who is randomly targeted by a devil who attacks him with superhuman strength and intending to cause maximum damage. I'd say that if a person gets punched while they're in church with their eyes closed praying, or while alone in a library, lost in thought, reading a book, then that's pretty cowardly - and, yes, that's exactly like the kind of the story the media sell to us... but it's not usually the whole one.There is never mention that these kinds of things actually usually happen in areas filled with intoxicated persons, in the late hours of night, and what other combustants for social disorder are about. I'm certainly not saying that you deserve to get punched in the head if you happen to want to have some fun out in the town at the early hours of the morning where others are consuming drugs or alcohol, I'm simply saying some situations are inherently more dangerous. This is why our parents warned us about these situations. It's not all about inherently-bad people and inherently-innocent people.

How about if instead of negatively-labeling certain men who get caught up in bad situations, we do something a little more productive?  I don't have the answers, but perhaps we need to start asking better questions. Something like what role does alcohol play in violence? what other factors contribute to violence? how can we better educate men about avoiding violence rather than retroactively calling them 'cowards' and 'thugs'? what would be some alternative/healthier measures of masculinity we can inculcate into our young men to aspire to? These are just my opinions and suggestions, but maybe it needs to be something more of us think about.