Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

An Amalgam In The Exam Room

This post is an amalgam. Not the kind that fits in your back molar, but the kind that exists in my head. I’m trusting you have this type of overlapping-quilt-like-consuming-idea-thread that resides in your head at times and ultimately becomes thematic. How one event in life opens a new window into others and then suddenly there is sense and commonality in different spaces and experiences. You know what I mean? Evolving wisdom or simply experience, I don’t know. But I mean how something persists in your every-moment and helps you define meaning  with each new space and time. I’ll explain…

On Monday, a blog post of mine from last summer was published on Dr Kevin Pho’s blog, KevinMD. The post detailed my mom finishing her chemo and 5 words that her oncologist spoke one sunny afternoon: “You’re the picture of health.” The post is about the power of a physician’s words and how words spoken in the exam room linger in our life. In this post, I spoke about words we hear as patients (and caregivers) and how it’s essential that doctors detail wellness when they see it (rather than always focusing on illness). But reading the post again brought me back to last summer. More than once this week (let’s be honest, maybe like 6 times) I’d think about the post and well-up with tears. Maybe it’s the reality that we all face mortality or that I’ve been ushered into a new moment with my mom in her current remission where I am not filled with worry every day. Or maybe it brought me back to the emotion that was in the exam room that day, too. The same emotion I’ve typically divorced myself from. But,

It got me thinking, how was it I was starting a blog, helping my mom through chemo, moving to a new home, and caring for two little boys while caring for a panel of patients during that time? Why wasn’t I in a puddle of tears? Well…see…we do this. Parents (and children) do this ALL THE TIME. They muster incredible courage. Parents face fears. They exceed expectations and bust through boundaries for their children. For example, in the exam room, I tell parents we’re admitting their child to the hospital and then they listen, they thank me, they discuss.  They rise up to what is asked of them without their heart falling out of their chest and landing on the floor. They endure. They “keep it together,” they advocate. They share. Yes, they break down sometimes, too. Yes, they tremble. But they always do what they need to. They endure.

Which got me thinking, we really can be the balogne in the generational sandwich. Read full post »

Changing The World: Gates’s 36 Cents

Bill Gates recently said, “Not everyone can go into the field or donate. But every one of us can be an advocate for people whose voices are not heard.”

Ditto to what he said.

Watch Gates’s annual letter (below). This modality for telling stories is delicious and the message here is simple yet full of heart. However, like most things in life, it is not without controversy or a difference of opinion. As reported today in The New York Times, some feel Gates is off target.

I got a boost of energy listening to Gates today. It’s good to hear about progress. And even better to feel hope in the war-torn-rioting world in which we live.
Mr Gates describes efforts needed to complete polio eradication around the globe. He also points out the value of 36 (18+18) cents. Most vaccines are cheap. And although you can’t protect a child from measles for 36 cents in the United States (think co-payments and/or administrative fees), you can elsewhere. Particularly when Bill and Melinda Gates are picking up the tab.

I love to witness those with big dreams and lofty goals; it’s how and why our world progresses.

This video is worth the 4 minutes it takes to view. Both for its message and for the enjoyment that comes in watching the pictures unfold.

500 Words on a $5M Fine

No photo for this post. You can imagine why.

I’m a little stunned by the news that a politician in Florida is trying to stifle pediatricians from asking questions about guns in the home. My reaction is utterly predictable. Should I YELL IT or write it down or leave it up to your genius (and imagination)?


The Skinny on the Florida Proposal:

  • Florida Rep. Jason Brodeur said “he has heard about a number of cases in which doctors asked about guns. He thinks the topic should be off-limits.”
  • Brodeur says he’s concerned about doctors asking patients about guns in the home. He’s concerned that information could get into the hands of the government or insurance companies.
  • Under the proposed legislation, a doctor could face a fine of up to $5 million or be sent to prison for up to five years for asking about guns in the home.

The idea of blocking the right to advocate for children is preposterous. Clearly pediatricians don’t like censorship, particularly when it gets in the way of protecting the lives of children. We don’t even like censorship from our patients; we like it when adolescents tell us the truth about having sex, doing drugs, and self-tattooing. We like it when parents tell us what truly keeps them up at night. Really. Transparency and a lack of censorship is an imperative ingredient in the doctor-patient relationship. The exam room is a space and place where you’re not faulted for telling the truth. Read full post »

The Injustice of Immunization Interviews

When Dr Wakefield interviewed on Good Morning America today, an injustice occurred. For children, I mean. And it occurred inadvertently I suspect. But I believe this injustice happens all the time when it comes to childrens’ health and wellness. What the media covers really changes how we think and feel about protecting and parenting our children. The media’s effort to inform and educate, just like that of physicians and nurses, social workers and ancillary staff, researchers and students, can get lost and misconstrued. ABC worked hard to inform us of the accusations against Dr Andrew Wakefield with a 2 minute introduction by Dr Richard Besser, a pediatrician and medical editor/correspondent. Yet when the interview was over, I was left remembering the myth.

Today I awoke to the boys asking for breakfast. After getting them to the table with a bowl of Life (always strange to offer a cereal named after our existence), I poured milk in my own bowl. Suddenly I realized that I needed to get the recycling and garbage to the curb. I donned my boots and a coat, ready to haul the can and a number of collapsed boxes to the curb. But just as I headed out of the door, the phone rang. It’s when the day went from the typical day (“making” breakfast and moving garbage) to a day steeped in really trying to understand. My mom was calling, she said Andrew Wakefield was about to be on Good Morning America. I hit my personal fast forward button, flew to the curb with the garbage, and got back inside with enough time to hear the complete interview.

Dr Wakefield interviewed on GMA with George Stephanopoulos who later labeled the interview “combative.” Mr Stephanopoulos was given a terribly difficult task: he was interviewing Wakefield on one of the most complex, emotional, and loaded quandaries of the last few decades: vaccine-hesitancy and Wakefields’s purport linking vaccines to autism. When Wakefield failed to deny any allegations and failed to discuss the significant research that refutes his own work, Mr Stephanopoulos had to defend science. Alone. George Stephanopoulos isn’t gaining popularity (read the comments) with the anti-vaccine crowd and even some who doubt what Dr Wakefield claims. Yet ultimately, the 7 minute interview with Stephanopoulos and Wakefield simply stirs the pot. I trust it will have huge viewership. I worry that this is, in part, why it was done. Read full post »

A Living Mommy-Daddy Will

I’ve been struck by the death of Elizabeth Edwards. I keep coming back to thoughts about her. Like most Americans, on Monday I learned she was advancing to hospice care. After a long day in clinic on Tuesday, spent, I listened to NPR in the car on my commute home. It was dumping rain in Seattle, it was dark, the cars were moving slowly. NPR announced she’d passed away. What? Pause. Swallow. Take a right turn at the light…

I thought she had weeks. Tears welled up in my eyes; I felt caught off guard. I can only imagine the sadness of those who have known her.

I’ve been thinking of her, her children, and her life experience. I don’t know her, so of course my vantage point into her life is one similar to most–I only know what the media shared with me and what she chose to share with the public. I trust her texture is expansive and far more pronounced in person. I know so little about her, but I have heard her story and it is memorable. I am taken by her death likely because so often, she was identified as a mother.

Today in NYT’s Motherlode blog, Lisa Belkin writes about Ms Edward’s “Dying Letter,” a letter she composed for her children as she faced her mortality. People magazine reported on the letter while the Edwards family was on the campaign trail. I suspect like any letter from a mother, her letter is filled with story, memory, advice, wisdom, and legacy. Fortunately, we’ll never know. Only her children will.

But it got me thinking. Why don’t we all write this? Why don’t we all share, journal, and jot down our thoughts and ideas for our children before we face a mortal diagnosis or worse, an unexpected death. Why not collect thoughts/ideas/moments in time throughout our lives for our children. After I wrote a letter to F last year for his preschool emergency preparedness, I felt better. I know that if today an earthquake occurred while my son was at school, that while separated, he’d at least have my words and a photo. This task could function like a living will but not for our own end, rather for our childrens’ future. Today, a living-Mommy (or Daddy)-will makes a lot of sense to me, despite the onerous task of composing it.

Does it make sense to you to start an ongoing letter to your children? If you don’t feel like much a writer, how about a list of ideas/wishes/advice placed in bullet points? I suspect if any of us start this, we’ll never regret it. Neither will our children.

Will you do this?

Verbatim: Be A Dad

Recently I saw a patient for his 7 year old well child check. He was in the office with his entire family for an evening appointment. My medical assistant got his weight, height, blood pressure, and completed his screening exams. In the hall, she mentioned to me that he said he was going to be a scientist when he grew up. She was charmed (clearly) and I was weak in the knees when I entered the exam room. I mean, endearing and sweet, robust and proactive, his dreams exceeded the typical 7 year old. I suppose I thought this partly because of my path in life (science-y and full of many years of science education). Of course there is nothing ultimately graded about dreaming to be a scientist when compared to dreaming to be an astronaut, a carpenter, a designer, a gardener, a botanist, an artist, or a teacher (this list goes on and on). What we want for children is far wider than their title–what we want is contentment and enjoyment in their career.  Most of us often love when people tell us they want to be “us” when they grow up. It’s affirming, right? One reason you have to be careful from whom you seek career advice. For most, it will often sound a lot like a transcript of what they have done. I’ve been thinking about this since the visit because of what happened next… Read full post »


I did a live radio show for the the AAP’s Healthy Children radio show last week.

Click the above link if you’d like to take a listen or below for individual segments (each about 15 minutes).

My favorite part of the first interview is when I mention magic. Of course, the hard work of raising young kids is simply so worth it. We get so much more than we give. Nothing about this is easy of course, and nothing about this static, either. Take a listen and let me know if what you think.

Work-Life-Balance Issues for Working Parents

Breast Feeding, Working, and Being a Working Moms

Sitting In A Circle

Working-mom-struggle bubbling up. Work life balance. Feels like I’m sitting in a circle; there’s no corners to hide out in. Problem is, this circular spot happens about every 7 days. It’s Thursdays I’m talking about.

This Thursday I was away from home for 14 hours. I left for a talk before the boys awoke, and arrived home well after bed time. During those 14 hours, I was able to hear an incredible talk by Perri Klass on reading & advocacy via the Reach out and Read program, I completed a long day of clinic and saw over 25 patients, I completed an interview with a potential medical assistant, and I had two 30 minute commutes. I am really glad I had those opportunities. For one patient and his mother, I wouldn’t have missed the day. Hands down, good decision to go to work. But these long Thursdays eat away at me. Intellectually I understand trade-offs in life exist (duh). I understand with opportunity comes losses (duh). Despite this acknowledgment, I seem to go through an emotional evaluation every week. Something about Thursdays seems an utter failure on a personal level. A day starting and ending with zero time with my children seems simply preposterous. Outside the scope of travel, having a day go by on planet earth without a glimpse of my children, while coexisting in the same home, seems a minus. My motherhood isn’t supposed to look this way. Yes, I know mothers leave and travel; I know children divide time between parents. I know plenty of parents work harder and longer hours than I do. I know many other mothers and fathers carry more than one job. I remember my co-residents with children (while in training) left their homes for upwards of 30 hours at a time, every week. Yet every Thursday I feel this 14 hours-ish toll. Even though I know my kids endure these long days well, I don’t. The balance between our time at work and our time enjoying our personal lives remains tricky. Read full post »



I’m smoooooshed today. Underwater. Submerged. Trapped under my orange scarf (see image). Just back from two consecutive conferences and readying to speak at another. And, drumroll……the in-laws show up in 2 days. I’m in that state of near-paralysis-parenting where there is so much to do I feel incapable of completing any of it. Every parent, working or not, has been here. Right? Here’s to hoping I’m not alone… I nodded my head about 12 million times over the last week when other docs I met at the AAP conference talked about the juggle between work and parenting. One pediatrician, Dr Alanna Levine said, “There isn’t an instant of time left unscheduled.” Yes, and today I’m behind on that schedule.

I started sobbing at my computer this morning after our nanny came home to tell me that I had forgotten it was picture day at preschool. Of course, I wasn’t crying about the reality that F went to school in an old T shirt and a cock-a-doodle-doo hair style (he went straight to bed after family swim last night). No, this is not about vanity or being uptight. I was crying because it feels like failure sometimes when you forget details in your parenting life. F couldn’t care less about what shirt he wears for the photo, and I certainly need to think about that, too.

So as I scour the planet for a shovel big enough to dig me out of this hole, I wonder, what would you most like to hear about this week and next?

My Ideas:

  • Blog post on recent update on recommendations for preventing, treating, and caring for kids with concussion.
  • Blog post on a list of recommended booster seats. And the whys in using booster seats.
  • Why I hate infant sleep positioners and why I think they put kids at risk for SIDS. Don’t believe the advertising hype that they are good for your baby. Video or blog post.
  • The AAP published new recommendations for iron intake in infants and toddlers.  Want to hear about it?

Tell me what you want me to write about; vote below. Yes, I’m asking for audience participation. And, ummmm, do you have a sturdy shovel I can borrow, too?