Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

Partnerships In Health Care

I got a parking ticket today. It was worth every penny. The logistics behind why I was in the wrong spot don’t matter (do they??). What does matter is the fact that I made a conscious decision at 10:30am that I was happy to pay the fee that was going to be coming my way if I didn’t exit the building.

I was able to attend a portion of the Pediatric Bioethics conference entitled “Who’s Responsible for the Children” this morning. I was planning to return to other work after a couple of talks. But I couldn’t pull myself away. In perfect form, bioethics’ discussions draw a feisty and varied crowd. In keeping with this, I sat between a lawyer and a nurse, behind a pediatrician, and in front of a philosopher. For someone who has studied bioethics, this is a little bit of nirvana.

Did you know that recent data finds that 40% of children in the US have Medicaid and/or no health insurance?

I’m left reeling, my head spinning webs of thoughts and streams of information together that make me want to do more, speak out, stand on a table and improve health care for children. I’m somewhat humbled and intimidated by the brilliant thinkers I heard. So until all that settles, there’s one thing that came up, and often does, that I must write about. It seems it’s a theme. Read full post »

Thrilled To Be in Primary Care

Being a primary care doctor is an utter privilege. Think of this post as part proclamation and part journal entry.

Yesterday afternoon I sent out this tweet:

It was a spontaneous tweet in the middle of my 15 minute “lunch break” when I realized I still had hours to go in my clinical day. The motive was incredulity, not remorse or a need for pity. I was in a good spot–my frame of mind and perspective sharpened twice this week.

First, I’d had a discussion with clinic  leaders where we noodled around the upcoming fall where I will be traveling heavily and unfortunately away from clinic. We were discussing how to meet the needs of my patients while simultaneously meeting my need to contribute nationally. I reminded them how I’m unwavering in my adoration for my panel of patients and my commitment to caring for them. They nodded. You see, they know….. Read full post »

5 Things We Shouldn’t Do

I really want you to trust your child’s doctor. I really want them to trust you, too. Partnership is key to any relationship. Recently an article was published in the Archives of Internal Medicine entitled The “Top 5” Lists in Primary Care. It sounded more like a blog post than an article. In media summaries, reporters wrote about less being more. Not surprisingly, it was right up my alley. Like I’ve said many times before, in medicine, less is often more. Partnering with your child’s doctor is essential in assuring that when nothing needs to happen, nothing does.

This list is a reminder for us all.

The group authoring the article is part of the “The Good Stewardship Working Group” and represents 22,000 physicians for the National Physicians Alliance. Their intentions: to find 5 things “not-to-do” in primary care. For pediatrics, the committee used evidence (Cochrane reviews, AAP/AAFP Guidelines, The FDA, NAEPP), experience in the office, and field testers (pediatricians) to generate a list of what to avoid/what not to do, to avoid harm. The goal is to improve health, reduce burdens both financially and physically, and ultimately to empower patients, parents, and pediatricians to avoid unnecessary testing and intervention. I’m sharing them here because good care is partnered care. Being a strong, informed parent is likely the best asset your child will ever have in a health system. Parents need to know this list. If I could tattoo it on your arm, I would. You’re the strongest and most motivated person to advocate for your child. You’re also the most likely to help avoid unnecessary and dangerous intervention alongside the doctor or nurse caring for your child. The “don’t” list according to this group: Read full post »

I’m A Physician On Twitter: Patient Privacy

On Monday night, Dr Bryan Vartabedian, a pediatric gastroenterologist in Texas, wrote a blog post about physician behavior on Twitter. In the world of health and social media, it’s caused a near nuclear explosion of thought, an outpouring of opinion, and most importantly a much-needed discussion. Discourse is perfect for progress.

I think about this all the time.

In the post, Doctor V called out an anonymous physician blogger and tweeter, (@Mommy_Doctor), on her tweets about a patient suffering from an embarrassing and painful medical condition. Nearly 100 comments later and numerous other blog posts, physicians and patients are openly battling and exchanging perspectives.

I wonder, what do you think? I rarely write about patients directly. More, I write about what I learn from patients. I never want a patient or family member to stumble upon anything I write and wonder if I’m writing about them. When I have written about patients, I have asked permission and even then, waited for a period of time before writing about them to avoid the time-stamp the internet provides. Read full post »

Pile On The Paperwork: Vaccine Exemption In WA State

I’m happy about a new pile of paperwork coming my way. To be clear, I’ve never said this before. But I’m serious. Instead of stewing controversy, I suspect a new bill around here could open up lines of communication. I’m not living under a rock; I understand that some feel this new bill requiring signatures for vaccine exemption is heavy handed. I wholeheartedly disagree.

Yesterday Governor Gregoire signed a new bill into law that will demand families talk with a health care worker about the risks when exempting from immunizations. It turns out, WA state lags in their vaccination rates compared to national averages. In the last 10 years there has been a doubling in the number of students with exemptions for vaccinations in our schools. The biggest reason may be a convenience factor. The state suggests that 95% of exemptions are not for a medical reason, but one for convenience. Seems like you’d never opt out of immunizations for convenience putting your child or another child at risk. Right? But then think about how nuts your life is, how chaotic it is to raise children, and work, and pay bills and and and….

Imagine this: you’re a busy mom/dad, your child is about to start Kindergarten or 6th grade. The records you have for their immunizations are incomplete. You didn’t keep the book and like me and everyone else, your paper work isn’t filed perfectly. You’re pretty sure your child is “up to date.” You’re standing at registration at the school. You’ve been waiting in line and your left heel hurts. Come to think of it, your head hurts, too. Your daughter just tugged on your pant leg; she’s hungry. Quickly, when you realize you’ve got an incomplete record, you call your daughter’s doctor office while still in line. No one picks up when you call and you’re put in a queue waiting to talk with someone in medical records. You have a choice, would you rather just sign your name, exempting your child from vaccines, or go on a hunt for the records to ensure your child truly is up to date? Sure, the answer for most any parent is clear.

You sign your name. Read full post »

Happy Mother’s Day









Happy Mother’s Day. If anything, holidays like today place a stamp on this day amidst the irrevocable march of time. Photos, cards, gifts, mentions, and memories..a moment or day where we reflect, compare, and remember with those from the past. Last year on Mother’s Day it was sunny, my family had a picnic on a hill with fried chicken, and neither of my children were old enough/able to make a homemade card. We played airplanes (the kind where kids fly on your legs), drank sparkling water, and I celebrated my mom’s health amidst a cycle of chemotherapy. It was a good day; I felt love and loved, simultaneously. Sandwiched in the best way I know. Read full post »

Finding Friends Online

As I work to encourage more physicians and health care workers to join me in social media, I stopped yesterday, to reflect on how much I enjoy and have grown personally and professionally because of my online community. Social media tools certainly aren’t just about what I say–my community online is far more about what I learn. I have made some real friends via social networks and Twitter. This virtual space is very real to me. My patients and families in clinic tell me this often, too. I have a whole new set of comprehensions, friendships, and perspectives because of these friends (and foes). Social spaces are important to me. Although I’m constantly out of balance and need to find more time to unplug, I wouldn’t ever want to leave this cyber space. I’d simply miss my friends. Many of them live far away; I can’t invite them over to dinner.

Last week I tweeted about a dream I had about Dooce. She’s the queen bee of mommy bloggers. I’ve never met her (would love to, clearly) and thus my thoughts metamorphosed into a dream. I’m a big teller of dreams. Haven’t you had a vivid dream about someone, run into them the following day, and felt you knew them much better? All fictional, maybe, but relevant to your reality. I usually out myself and share my dream. Foolish maybe. Most others, it appears, worry about the vulnerability of doing so. So recently it was a treat to check my email amidst a very busy day when… Read full post »

Lunch (Time) With Alison Singer, Advances in Autism Research

Tomorrow I have the privilege to give opening remarks and introduce Alison Singer. Ms Singer is the founder and president of the Autism Science Foundation. She’ll speak about advances in autism research in honor of National Infant Immunization Week. Ms Singer has a daughter with autism as well as a brother with autism and has worked for both Austism Speaks and with the Interagency Autism Coordinating Committee to provide leadership on strategic goals for autism research at the national level. She’ll speak about her belief that immunizations do not cause autism while highlighting goals for ongoing research and education efforts to support families with autism. Everyone is welcome; please join us! Read full post »

Monday Phone Call

I called my doctor today. Well, I called her office, of course. I needed an appointment to see her this week. First available appointment was next Friday (11 days). “Okay,” I  thought, settling, “That will do.”

But forgive me, let me rewind. The receptionist asked me for my medical record number. Before my name. It was the first question he had for me upon answering the call. When I didn’t have it, he started with my first and last name along with my birth date. We found my record without trouble. But he noticed it had been 5 years since I’d been in. This brought trouble.

I said, “I’ve been having babies, so my OB has been doing my preventative care,” to which he said nothing. “Well,” he said, “I’ll have to e-mail the doctor. She’ll need to agree to see you since it’s been so long.” It gets worse: “It’s going to be another week until we know,” he said. “She’s on Spring Break this week, so it may not be until next week that you hear if you can get in. Unless she is checking e-mail while away.”

Oh, I hope she’s not checking e-mail on Spring Break. Really. But, Read full post »


Recently, I started asking a standard question, exactly the same way, to children during their 3 to 10 year old check-ups. This wasn’t premeditated. Like all physicians, I go through phases of what I ask kids to elicit their experiences and beliefs, listen to their language and observe their development. I learn a lot about my patients from what they choose to answer. Both in their receptive language skills (how they understand me) and their expressive skills (how they speak–fluidly, articulately, with sentences) to their cognition (how they understand concepts and theories). No one talks as much when in the exam room as they do at home. Pediatricians know this (of course!), but these questions are a great way to learn a lot about a child’s wellness and get to know my patients. It’s also the part of the day I enjoy the most.

But when I started asking a recent question something became utterly clear. I’d say,

“What do you like to do at home?”

I expected the usual suspects. Things like, “Watch TV,” “Play the DS,”, or “Play with princesses or doll houses.” Not that I expected stereotypes, I just expected specifics. But instead, there has been a uniform, single-word response. Breath-taking. These children are all saying the exact same thing.


One word. Read full post »