Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts

July 25, 2015

Med Student Takes selfie as he Performs cesarean exposing patient genitals

In Lima Peru, Doctors perform cesarean exposing the patient genitals and face.
 This case is in addition to the medial student story.
Doctors performing a caesarean. Photo via Flickr
This article originally appeared on VICE UK.
 "Lady I can deliver your baby but first let me take a selfie," wrote smooth-talking Venezuelan student obstetrician Daniel Sanchez on his Instagram page last week. In the accompanying picture he smirks at the camera while a woman, naked from the waist down, gives birth behind him. Another obstetrician’s fingers are still in, or around, her vagina as she begins crowning.
 Med Student Daniel Sanchez
 Sanchez (who has since set his Instagram account to private) went on to boast that his team can "bring kids into the world and reconstruct pussies," claiming their skills are such that women (and implicitly their partners) can look forward to being "brand new, like a car with zero kilometers on the clock." How splendid, say the image's 31 likers. Unfortunately for Sanchez, more than 4,000 people who signed a petition calling for disciplinary action to be taken against him think it's less acceptable.
In an email exchange with the petition's creator (Jesusa Ricoy of the Roses Revolution, a global movement against obstetric violence) Sanchez has apologized for any offense while denying taking the picture himself. He carefully mansplains to us all that the woman in question is respected because "you cannot see her genitals or her face" and assures that she gave consent. He's also keen to make it known that he is one of the most empathetic students on the team and that women often request that he specifically perform their vaginal examinations, saying, "doctor hagame el tacto usted que es mas delicado" ("doctor you touch me because you are more gentle").
Even if Sanchez did gain the unidentified woman's consent before displaying an intensely private and vulnerable moment to the world, his priorities were skewed. She was busy pushing a small human out of her body. Having done that a couple of times myself I'm confident that posing for a photo wasn't at the top of her to-do list.
But that's only part of the problem. Most shocking to me is the power dynamic in the photo. The woman is surrounded. She's on her back, at a moment of birth where she can't move even if she wanted to. The doctors are standing, uniformed against her nudity. They have faces, feelings, and agency. She has been reduced to a torso. A reproductive channel to be rooted around in without regard.
Jesusa Ricoy started the online protest against the image to "tackle the culture in which this kind of thing is permitted and accepted." Her movement was founded in response to a series of cartoons in the Spanish Society of Obstetricians and Gynaecologists journal that shamed, mocked, and sexualized women. With oversized breasts matching their inane questions, reduced to splayed legs and genitals in stirrups or running with a vaginal prolapse dragging on the ground to the delight of chasing dogs; it was clear how these doctors viewed the women they were supposed to care for. Despite protests, the Society has never apologized for the cartoons.
Sanchez's photo isn't a lone example. This image of an apparently unconscious, naked woman after a caesarean section was again posted online by doctors. Over this weekend Ricoy found another medic instagramming dubious birth images. Nurse Francisco Salgado has now deleted his photo showing the post-birth stitching of a woman's perineum. A tastefully blurred and bloodied vagina and thighs is the background of an in-focus head attending to her. Salgado has added a caption that reads; "someone will be in my eternal debt #thankfulhusbandsstich." The “husband stitch" refers to the practice of painfully suturing a woman's vaginal opening to be smaller and tighter than before birth.
Of course the images in and of themselves aren't the real problem. They are simply hieroglyphics for much of what's wrong with the way women are treated in childbirth and, more broadly, throughout their reproductive lives. Away from the filtered reality of Instagram, the power is still usually in the wrong place.
Venezuela was the first country to legally recognize the term " obstetric violence." The law forbids abusive practices and anything that brings with it "loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women." The legal definition has provided hope around the world, but the reality in many Venezuelan hospitals is still grim.
In Brazil last year Adelir Carmen Lemos de Góes was taken from her home by police and forced against her will to have a cesarean section because doctors didn't agree with her birth choices. Routinely, according to the recent Birth in Brazil study, vaginal birth is a lonely world of pain. Women are denied the opportunity to have a companion, access pain relief, or the freedom to move around in labor. The caesarean section rate is out of step with women's preferred choice of labor with a recent study showing that while 73 percent of women want a vaginal birth, 50-80 percent of them end up with cesarean sections.
This isn't a problem unique to South America. It's so endemic that the World Health Organization has launched a campaign explaining that "across the world many women experience disrespectful, abusive, or neglectful treatment during childbirth in facilities. These practices can violate women’s rights, deter women from seeking and using maternal health care services and can have implications for their health and well-being." While those in the developing world are often hit hardest by abusive practices and a culture that dehumanizes childbearing women, it would be naive to think this doesn't impact women closer to home as well. Activists Cristen Pascucci and Lindsay Atkins's newly launched "Exposing the Silence" photo project documents women in the US who have experienced obstetric violence. There are equally shocking forced cesarean cases in the US and a rising culture of punitive measures against pregnant women who seek to restrict their reproductive freedoms more broadly.
The UK does better, but women still report intimate, surgical procedures being performed without their consent. A lack of dignity and compassion is cited time and again in investigations into failing maternity units and tragic, avoidable deaths. Women say that they are made to feel like vessels, not human beings, in birth.
Humanity is the key to breaking down acceptance of practices that not only humiliate, imprison, endanger, and abuse women, but eat away at their basic rights. In South America the extent of the problem has provoked a revolutionary solution. Thehumanizing birth movement (resulting in government-sponsored programs like the Stork Network in Brazil) pushes for safe and quality care with a woman-centered, respectful approach at all times. Putting basic human dignity back in to childbirth and reversing the power balance is an approach now being watched and emulated around the world.
Forced cesareans, obstetric violence, and dehumanized care can seem a world away from an arrogant junior doctor with a selfie-stick. But women are shamed and dehumanized in the birth room every day. Their heads may as well be cropped out, as in Sanchez's photo, as they lie stranded, just identity-less vaginas awaiting rescue or pillage; the balance of power tipped entirely in the wrong direction. It's women, not doctors, who "bring kids into the world." Let's start with getting that on the first page of the obstetric text book.

June 24, 2015

Doctor Looses License for Sexually Gruesome Experiments on His Trainees

Image result for john hagmann md
 RICHMOND — John Hagmann, a 59-year-old doctor accused of sexually assaulting and performing gruesome experiments on his trainees, had his medical license revoked Friday at a misconduct hearing of the Virginia Board of Medicine. 
“Let it be noted that it was unanimous,” misconduct panel chairman Kevin O’Connor said. “I’d like to thank the courageous medical students who came forward in this case.”
Hagmann never showed up to the hearing, which came as no surprise to the Board. “I was informed twice last week by his counsel that Dr. Hagmann intended not to attend,” Virginia Senior Assistant Attorney General Frank Pedrotty said at the beginning of the day’s proceedings.
This was confirmed by Hagmann’s attorney, Ramon Rodriguez, who said that Hagmann is out of the country and requested more time to prepare for the hearing.
“All Dr. Hagmann sought was a fair hearing of the facts where he could be present to answer the Board’s questions, provide witnesses and defend himself,” Rodriguez told BuzzFeed News by email. Rodriguez also said that Hagmann “intends to appeal what appears to be a clear violation of his constitutional right to due process.”
Hagmann’s license was suspended in March, two years after an anonymous student first reported his abusive behavior to the Uniformed Services University, the military school where Hagmann often conducted trainings.
Witnesses testified to a panel of nine doctors that Hagmann gave students dangerous drugs while they were inebriated, and performed unnecessary penile nerve blocks and rectal exams on them. Hagmann also allegedly asked students to perform rectal exams on himself, among other procedures that raised alarm on the panel. 
“Everything was just so abhorrent and abnormal,” said John Prescott of the Association of American Medical Colleges, who testified at the hearing as an expert on medical training. “In a combat situation, there’s no need for a penile block, ever.”
The hearing followed a report from the Virginia Board of Medicine, which was released in March and discovered by PETA in May. The report details how Hagmann had abused his power since at least 2012.
“The evidence was so overwhelming and bizarre that it was almost shocking to the conscience of a prosecutor who has been doing this for 26 years,” Pedrotty said in his final argument. “He represented a real and present danger to the health of his patients.”
It’s unclear whether Hagmann will face criminal charges, Pedrotty told BuzzFeed News. He added that it’s “unlikely” because in a criminal case Hagmann’s students would be regarded as volunteers.
Hagmann allegedly left the metal tip of a lidocaine infusion device in Patient C’s chest, then had to remove it mechanically from his breast bone without sufficient anesthesia to forestall “extraordinary” pain. According to Patient C, Hagmann disparaged the suturing skills of Special Forces medics and walked away saying he was disgusted by a bad sewing job.

“When we look at all of these things, we see a lot of problems all across the board,” said panel chairman O’Connor after Patient C’s testimony. “The themes we keep coming back to are coercion, isolation and predation,” he said later in the hearing.
“I am shocked as we all are,” said panel member Maxine Lee, in response to testimony from another medical student, “Patient A,” who said that Hagmann had repeatedly catheterized him.
Patient A also testified that Hagmann had performed a long rectal exam on him, and then said he realized he had “violated” the student and offered to let the student similarly examine him, in return.

An Army Captain who testified as “Individual E” by phone, said that during one of Hagmann’s courses, the handle of a medical device broke off while it was attached to her shin bone and had to be removed with pliers, under a procedure conducted with only a local anesthetic. “I started crying,” she said. “It was very painful.”
In July 2013, at a DMI training in a warehouse in Partlow, Virginia, Hagmann drank beer with a man, “Patient B.” This man then performed a penile and rectal examination on Hagmann, who videotaped it.

Patient B testified that he also allowed Hagmann to examine, manipulate, and photograph his penis. Hagmann was apparently interested in Patient B’s penis because he wanted to know “the effect his uncircumcised penis had on masturbation and sexual intercourse,” according to the Board’s earlier report. Hagmann also took photos of the student’s foreskin in “various stages of manipulation,” saying the pictures were a “training tool.”

That same month, at DMI’s 20-acre facility in Pink Hill, North Carolina, Hagmann allegedly forced students to take between five and eight shots of liquor in 20 to 30 minutes, then injected a few of them with the dissociative drug ketamine. He then encouraged drunk students to perform nerve blocks on the penises of classmates who had been given ketamine, according to the report.

At the hearing, Pedrotty said that repeated attempts were made to get Hagmann’s response to these complaints. Hagmann has not returned phone or email requests from BuzzFeed News.
Army Colonel Neil Page, who investigated the charges for USU in 2014, said that Hagmann hadn’t denied that any of the procedures occurred, but characterized them as standard combat medicine education.
Medical students prepare to testify before the Virginia Board of Medicine. Jay Paul / Reuters / Via
John Hagmann receiving “Outstanding Uniformed Educator Award” at USU in 1989. 
Reuters / Uniformed Services University of the Health Sciences Handout

Hagmann’s company, Deployment Medicine International (DMI), has taken $10.5 million in taxpayer dollars to run classes on combat medicine for members of the military.

“Everything we do is oriented towards saving lives in a theatre of war,” reads a DMI brochure. “DMI is the most experienced and professional corporation in this genre of medicine.” 
This blog post from 2012 shows photographs of Hagmann carrying out medical procedures on students in the U.K., sometimes without gloves.
DMI has been awarded almost $700,000 in Department of Defense contracts since the Navy claims it first learned about Hagmann’s gross ethical misconduct in July 2013, including a $343,800 contract from the Navy a week after a student came forward with allegations of abuse. Hagmann was suspended from receiving defense contracts last week. 
On Wednesday, Reuters reported that several high-ranking military officials have known about Hagmann’s disturbing teaching methods since at least 2005. In email exchanges with Reuters, Hagmann wrote: “In 25 years no one has ever been harmed. What military training — or even most sports — can report that?”
U.S. Army Colonel Neil Page, who led a USU investigation into Hagmann in 2014, testified that Hagmann had retired from the university in 2000 under a dark cloud after getting unprofessional conduct job ratings. 
A one-time pioneer in combat resuscitation medicine, Hagmann returned to teaching at USU in 2012 on the strength of his reputation and the turnover of leadership at the school, Page said, producing “amnesia” about his questionable activities.
On July 24, 2013, a USU student reported troubling behavior from Hagmann, at which point the university suspended its relationship with the company, according to USU spokesperson Sharon Holland. 
The school notified the Naval Criminal Investigative Service five days later, she added, then contacted the Defense Criminal Investigative Service within 48 hours. A Defense Criminal Investigative Service representative declined to confirm or deny the existence of an investigation to BuzzFeed News. 
The university conducted a “comprehensive internal investigation,” Holland told BuzzFeed News by email. That was completed in December 2013. But the report wasn’t sent to the Virginia Board of Medicine until February 25, 2014. It then took more than a year for the Virginia Board of Medicine to temporarily revoke Hagmann’s license.

The original tip to Reuters came from animal rights group PETA. 

Military medic trainings sometimes use pigs and other live animals to teach trainees how to treat injuries such as bullet or stab wounds in the field.

PETA had been tracking DMI since 2013, when a student of one of the live animal training classes sent the organization a video of the treatment of animals. 
In the video, a student asks an instructor with his face blurred whether the pigs could be replaced by a mannequin. The instructor, presumably an employee of DMI, responds “Hajjis could do it, that would be even better. But it’s not politically correct, and we can’t do that.” Hajji is an honorific given to Muslims who have made the pilgrimage to Mecca. Some members of the military have adopted the word as a derogatory term for people from the Middle East. 
Now that the investigation has been made public, PETA is suspicious of the way the Navy seems to have punted responsibility to the Virginia Board of Medicine. 
“It seems odd to me that an institution that prides itself on self-policing like the Department of Defense — if they did have information about the abuse of soldiers, why did they turn it over to a third party?” Justin Goodman, PETA’s director of laboratory investigations, told BuzzFeed News.

 A detainee in 2003 at the Abu Ghraib prison in Baghdad, Iraq. Associated Press / Via

Others have also called for an end to the use of animals in these trainings, including Hank Johnson, a Georgia Representative on the House Armed Services Committee. 
Johnson first learned of Hagmann’s exploits when a Reuters journalist contacted him for comment in the article that brought the story to the public eye, on June 8th. 
After reviewing the case and discovering DMI had its eligibility for federal contracts renewed in May 2015, Johnson sent a letter to Secretary of Defense Ashton Carter asking for a detailed investigation into the allegations. 
In addition to the animal issue, Johnson worries about using contractors for such important and sensitive courses. “We definitely need to always ask the question, why are we contracting out that training capacity?” Johnson told BuzzFeed News.
Military contractors may lack appropriate ethical oversight.

When it comes to contractors, “you’re not being directly monitored, and to the extent there is monitoring it’s probably paperwork compliance,” Jonathan Moreno, a bioethicist at University of Pennsylvania who specializes in national security, told BuzzFeed News.
That said, even if there had been more oversight, Moreno said, “the rules are not designed for people who are nuts.”
USU had not submitted Hagmann’s course for ethical review before hiring his company. “Prior to the disclosure of the inappropriate procedures used, the DMI training courses were well regarded around the world for many years,” Holland, the USU spokesperson, told BuzzFeed News by email.
This is one of several recent cases of military contractors grossly violating ethical standards due to lack of oversight.
In 2007, employees of Blackwater Security Consultants murdered 17 Iraqi civilians and injured 20 others in what is now known as the Nisour Square Massacre; four of the employees were later convicted of murder or manslaughter.
Likewise, the torture at Abu Ghraib prison was carried out by both service members and employees of CACI International and Titan Corporation. Though some soldiers faced consequences, including jail time and dishonorable discharge, no contractors were punished, and U.S. courts decided that the corporations had immunity from litigation.
Cases like these are making lawmakers take a close look at the use of contractors, which the military often uses as a way to reduce costs. According to a government report, more than 50% of the military is made up of private contractors.

August 19, 2014

Keeping sane as Medicine is gone Crazy


Medicine is moving at Mach speed, and physicians are in the middle of its path. Regulation. Consolidation. New technologies. With so many forces bearing down on doctors, how do you stay sane?
We asked physician experts and consultants to talk about the leading causes of dissatisfaction and burnout among physicians, and to give practical advice on handling them.

Doctors Face Challenges From All Sides

There are plenty of overarching macroeconomic forces unsettling doctors: a sluggish economy, uncertainty about the impact of the Affordable Care Act, and the rise of narrow provider networks, just to name a few. But these big-picture stressors often take a backseat to the everyday headaches that fill a physician's long days.
Four out of 10 respondents to Medscape's 2013 Physician Lifestyle Report say they're burned out, and it isn't the distant, foreboding pressures that are primarily to blame. Instead, doctors cited a couple of everyday, pervasive reasons: "too many bureaucratic tasks" and "too many hours of work."
Not surprisingly, these common complaints share some underlying causes.


Office visits squeezed into packed schedules are a constant strain on physicians, says Christine Sinsky, MD, an internist in Dubuque, Iowa. Clinical care has become much more complicated. Patients are older, sicker, and often more overweight, and physicians are expected to monitor and document far more information than in the past.
"We have to do all this frantic multitasking, which leads to paying less attention, which leads to stress, which leads to burnout," she says.


Monitoring and documenting care has become more complex as a result of increased regulation, PQRS (the Centers for Medicare & Medicaid Services' Physician Quality Reporting System), meaningful use, medical home criteria, and other requirements.
"It's not just about doing the right thing for your patients," Dr. Sinsky says. "It's about proving to someone else that you've done the right thing, and sometimes the proving takes longer than the doing."
Clinical documentation is only the beginning. Physicians currently spend almost one quarter of their time (22%) attending to nonclinical paperwork, according to a 2012 survey conducted by the Physicians Foundation.[1] With implementation of ICD-10 to take place in October, that percentage will likely increase.
“We spend too much time away from our patients dealing with checkbox-type medicine, and that really interferes with patient care," says Joseph Valenti, MD, a Denton, Texas-based ob/gyn and Physicians Foundation board member.

More Factors Straining Physicians' Sanity

EHR Woes

Although electronic record-keeping has been a boon to efficiency in many fields, it has significantly increased physicians' workloads. In addition to the headaches associated with mastering new systems, doctors spend a lot more time on data entry and a lot less time looking their patients in the eye than they used to.


Whether they've gone to work as employees of larger groups or are struggling to remain autonomous, physicians are feeling the effects of market consolidation. Many employed doctors bemoan the loss of clinical autonomy and struggle to adapt to new corporate cultures. Meanwhile, their colleagues in independent practices must constantly struggle with making ends meet given their limited resources and competition from larger provider groups, which have the clout to negotiate better contracts with insurers.
Twenty percent of the 2000-plus physicians surveyed by Physicians Wellness Services (PWS) and Cejka Search as part of their 2012 Physician Stress and Burnout Survey were not employees -- a number that closely aligns with the 14.2% of respondents who cited "financial issues such as the cost of running a practice, debt, etc." as a major cause of stress.[2]

Staying Calm, and Keeping Your Spirits Positive

Daunting as these challenges may be, experts say physicians can chip away at them if they're willing to reconsider their practices and adjust to shifting demands. Here are some steps you can take now to help you stay in control.

Build a Team

Dr. Sinsky, one of six researchers who studied nearly two dozen high-functioning primary care practices for an article published in the May/June 2013 issue of Annals of Family Medicine [3] says teamwork lies at the heart of addressing many of these frustrations.
"We can't deliver the outcomes we want for the future with the practice model and the staffing model of the past," she says.
For instance, a physician who works with a part-time medical assistant or a different medical assistant every day can't optimally delegate responsibilities because the gap in their training and licensing authority is too great, which forces the doctor to deal with a lot of administrative work, Dr. Sinsky says. Working with a team of nurses or physician assistants enables physicians to build a more flexible staffing model, she explains, because doctors can delegate more and team members can share tasks depending on what's needed.
Here's an example of smart streamlining of tasks: "During flu season, you don't want a physician spending a lot of time putting orders in for over a thousand patients," Dr. Sinsky says. "That's a lot of clerical work. Instead they can have a standing order saying, 'Anyone who agrees to a flu shot can have one.'"
In the interest of saving time -- including your time -- it makes sense to draft written protocols for your staff, recommends Melissa Stratman, CEO of Coleman Associates, a Boulder, Colorado-based consulting firm that helps physicians redesign work processes. "Implement a couple of protocols a week. It will make employees' jobs more interesting and satisfying, and enable you to delegate. Discuss the protocols at staff meetings, and ask employees for their comments and suggestions," she says.
  Having a cross-functional team means a team member can handle patient documentation for the physician, Dr. Sinsky says. Although some practices may opt to hire designated medical scribes, Dr. Sinsky says it's advantageous to train team members to do the work, so that a practice has the flexibility to use them in other capacities when needs arise.

Reengineer Tasks

Ordering routine tests before an office visit saves the practice time and promotes better communication with patients, Dr. Sinsky says. With results already in hand, you can discuss the numbers with your patients and use the exchange as an opportunity to motivate them, set goals, and develop an action plan. Ordering tests in advance likewise eliminates the need to call patients with their results after the visit. Similarly, by providing multimonth prescriptions for patients with stable conditions, practices can avoid repeating the same work multiple times throughout the year.
Simply taking the time to educate your medical assistants about what you need and why you need it can save lots of time and free up staff to handle more clerical functions, says Stratman.
Shelly Reese/ Freelance writer, Cincinnati, Ohio
 adamfoxie blog advise: 
To the Doctor:
Ronald Groat, MD, a Minneapolis psychiatrist and consulting physician for PWS, reminds physicians to practice what they preach: Eat right, exercise, and spend time with your family and friends. "You have to remember your priorities," he says. "You can't forget -- and neglect -- the people and activities that are important to you and give your life meaning. If you can't find that balance in your existing situation, then you should consider how you can make changes. It may be worth your while to reduce your income if it translates to a better quality of life.
To the Patient:
If your Doctor or new young Doctor shows signs of unhealthy habits like, smoking, obese or bad hygiene you need to take a second look.  

July 28, 2014

Gay Health Doctor in NYC Taking Blood samples at a Sex Club

Dr. Demetre Daskalakis cannot fall asleep. Like they have for many physicians, years of late shifts and early rounds have battered his schedule and etched deep grooves beneath his tired, dark brown eyes. But while his colleagues toss and turn, Daskalakis spends his nights patrolling Paddles—a Manhattan S&M club where men check both coats and clothing at the door and pay $40 to wade through faux smoke and loud music in search of a tryst.
Behind the club’s cavernous common room, lined with ornamental shackles and blush-worthy murals, Daskalakis operates a cramped clinic out of makeshift office space. As men queue up for free HIV and Hepatitis C screenings throughout the night, Daskalakis (whom the men fondly refer to as “Dr. Demetre”) offers his humorous, down-to-earth counsel during their 30-minute wait for the results.
“Demetre’s level of engagement is outstanding,” Hunteur Vreeland, a promoter and host at Paddles, told me in the relative privacy of the nightclub’s staff-only bathroom. “He is an amazing fit, a friendly face for people who have questions about their health. He is just what the community needs.”

The self-described “gay health warrior” who fought to bring the clinic to the club, caught some media attention last year when he took to the streets to administer vaccines during New York City’s meningitis scare. In only a matter of days, with the help of the Gay Men’s Health Crisis, a New York City-based non-profit, Daskalakis vaccinated hundreds of high-risk patients and helped stave off the meningitis outbreak. 

Now a senior faculty member at Mount Sinai Hospital, and recently named New York City's assistant health commissioner in charge of HIV, Daskalakis, 40, has undeniable gravitas lurking beneath his boyish features. He recently began to collate lessons learned from those odd office hours at Paddles into a research paper published last month in LGBT Health, which shows that men at high risk for HIV may misjudge their vulnerability to the deadly disease.
“HIV risk has been swept under the carpet by medical providers,” Daskalakis says. “This study informs providers that HIV risk assessment needs to be a priority.”
But long before Paddles and published papers, the Harvard-educated infectious disease doctor was a public health advocate, searching for better ways to help the growing number of men who engage in high-risk sexual behaviors.
“Demetre works 24/7,” says Michael Macneal, Daskalakis’s husband of three years. “When I met him, he was already doing outreach in the gay community, passing out condoms and performing HIV tests.”
Macneal, a wiry fitness instructor with no formal medical training, helps out by sorting through piles of paperwork and following Daskalakis into nightclubs, standing guard outside his husband’s private medical consultations.

Daskalakis grew up in Arlington, Virginia, but felt drawn to the big city from a young age, so he enrolled in Columbia University immediately after high school. Daskalakis recalls the day that his parents drove him up to Columbia. “We crossed the George Washington Bridge, there was a car on fire and a dead dog in the gutter. My father said, ‘Are you sure?’ and I said ‘Keep on going!’”
As a student, Daskalakis’s maverick taste for the unknown brought him to Manhattan’s East Village on many a weeknight, where his brushes with LGBT nightlife would ultimately shape his perspective in caring for a diverse patient population. “I learned my bedside manner from East Village drag queens,” he jokes.
Although he followed a pre-medical curriculum while at Columbia, by his senior year Daskalakis was still unsure of what field of medicine he would pursue. But that changed once he became involved in a student-run campaign to bring AIDS awareness to the campus. The centerpiece of the event was the display of a patch from the NAMES Project’s AIDS Memorial Quilt, and the task of flying to San Francisco to pick up the artwork fell to Daskalakis.
Daskalakis says he felt as though he was transporting the legacy of the millions who had succumbed to HIV and AIDS. “It was a surreal experience. Here this quilt was just a rug, but I was carrying it through the airport [as] a shroud,” he says.
Only days later, still jet-lagged from his cross-country flight, Daskalakis attended the memorial ceremony at Columbia. “I remember being very tired, and just saying ‘This shouldn’t happen any more. I have to make sure this doesn’t happen any more.’”
Daskalakis was accepted into New York University’s medical school soon after, and went on to Harvard Medical School for his residency and fellowship in infectious disease. He quickly adapted to the culture of high-powered Harvard research, and began to see results from his laboratory work with acute HIV infections.

 While sitting here in Boston with petri dishes and cell culture, when I got into this field to help people directly?” he asked himself. That very day, Daskalakis packed for New York City, and began making calls to local hospitals to ask if they were looking for an AIDS expert who was ready to get his hands dirty. 
Now a familiar face in sex clubs across the city, Daskalakis fondly recalls a few of his early attempts to deliver care in less than ideal settings. “After drawing blood in a dark room lit only by tea lights that kept going out, I bet I could get blood out of a rock,” he says. On another occasion, Daskalakis recalls reaching for a syringe, only to be restrained by fuzzy novelty handcuffs and a smiling naked man.
Daskalakis is generally unfazed by such displays of fetishistic sexuality. But just because he sets up shop in commercial sex venues does not mean that he condones those sexual habits. “Do I love high-risk sexual behavior? No,” Daskalakis says. “But is it important to acknowledge it exists and not be scared of it? Yes.”

Daskalakis at work. (Joshua A. Krisch)

But those late nights at bathhouses and S&M clubs provided Daskalakis with far more than a handful of wild stories. Dr. Demetre has amassed a substantial database of anonymous questionnaires, filled out by patients while they waited for their screening results. In his research paper, Daskalakis analyzed these testimonials to show that 78 percent of his high-risk patients believed that their behavior did not warrant the use of pre-exposure prophylaxis drugs like Truvada.
The sobering lesson is that men who are at high risk for HIV continue to underestimate their chances of exposure. “People don’t recognize that they are at risk,” Daskalakis says.
It’s a slow Wednesday night at Paddles and, between patients, Daskalakis leans back in his folding chair and rattles off facts about state licensure and the nuances of needle sticks. He sifts through biohazard bags, a Chanel beanie propped atop his shaved head, a Harvard lanyard slung around his neck. He fiddles with his clipboard and flattens the wrinkles out of his tight black shirt, which reads: “Witch, Don’t Kill My Vibe”.
It’s hard to imagine Dr. Demetre anywhere else.

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