Doctoring & Healthcare

All Articles in the Category ‘Doctoring & Healthcare’

5 Things I Say (In Clinic)

Five things I say in Clinic (in no particular order). After reading this, you’ll be all set for Family Feud when the category is Things Pediatricians Say.

Number One: I’m so sorry you’ve been waiting for me.

The reason is often varied. I’ve not been picking my nose or even doing something as productive as blogging. Usually I’m running behind because a patient or two arrived tardy for check-in or I’ve had to return a call to a doctor at the hospital or a family needed more time for an urgent health concern or a patient scheduled an appointment to talk about one thing (say a medication refill) and then wants to talk about three things like starting birth control or their struggle with obesity or a new challenge at school or a rash or because I needed to “double book” a sick infant who needs urgent care. The reasons are unpredictable, clearly, and I hate to make anyone wait, but I also hate to have families leave without comprehensive care. I work my tail off (as do my magical medical assistants) to stay on time, yet inevitably I am set up to fail. It’s an unusual doctor who never runs even a minute behind in a general pediatric practice. I sincerely hate to have people wait for me, as it’s a huge added stress for us all. Starting all visits with an apology makes for a terrible day. So next time you find yourself stuck in some waiting room with your toddler (+/- your 3 other children) and you’re going bananas, know that when your child needs the extra time or attention, they’ll get it, too. And if they never do—lucky you. Read full post »

Plan B Back Behind The Counter

I was disappointed to hear the news that Kathleen Sebelius blocked the FDA’s recommendation to make Plan B available to all girls, over-the-counter (OTC). Plan B is an oral tablet containing hormones (similar to what is in a birth control pill) that when taken within 1 to 3 days of unprotected sex, can prevent an unwanted pregnancy. It is used as a back-up birth control. Primarily, Plan B works to delay ovulation thus making it less likely that a girl could be pregnant. Effectiveness increases the earlier a girl takes the pill after unprotected sex, so we want sexually-active teens to have it on-hand, just in case.

When it comes to Plan B, timing is everything.

Girls 17 and up can get Plan B for about $50 without a prescription. They can walk into any drug store, head back to the pharmacy counter, show an ID and purchase the pill to prevent a pregnancy. Those 16 years-old and under cannot; they must see a health provider to get Plan B. Trouble is, not every girl can see the physician when they want. Many girls at risk for an unwanted pregnancy may not have access to a clinician immediately or within a day or so. Further, girls may be too embarrassed or concerned about judgment to talk with their parent. And that’s where I start to worry; an unintended pregnancy can have significant physical and emotional health consequences.

Let me be very clear: I’m all for girls seeing their pediatrician for health advice. Read full post »

Pediatricians’ Conditional Comfort With Alternative Vaccine Schedules

I had coffee with Dr Doug Opel last week to discuss his study about pediatricians and alternative vaccine schedules that published today. I learned a lot while we spoke. There is great wisdom in what he said (below in the interview & on video) that extends far past what he learned in the study.

Dr Opel is one of those genuinely authentic, kind people. The kind of person you meet and wonder, gosh if only I could be a fly on the wall when he’s making decisions for his kids or decisions for his life or decisions for his patients–I’d be so much better off. Not just because I’d see the answer, but because I’d have a front row seat while he asked the questions. He’s just remarkably thoughtful so there is no wonder this study illuminated some helpful observations.

Dr Opel and his colleagues conducted a survey of WA State pediatricians to find out how often they were being asked about alternative vaccine schedules and how doctors felt about it. Seventy-seven percent of pediatricians reported they are regularly being asked to use an alternative vaccine schedule. And in general, the majority of pediatricians (61%) are comfortable with alternative schedules but only for particular vaccines. Meaning that although pediatricians are okay with parents’ request to delay some vaccines (Hepatitis B vaccine or Polio) they are not comfortable waiting on others (DTaP, Hib, or PCV). The reason, Dr Opel suggests, is that pediatricians are unwilling to leave kids unprotected for potentially devastating diseases that still circulate in our communities.

In this interview, Dr Opel lends insight to the culture of concern about vaccine safety, how the changing health care environment has shaped how we ask questions in the exam room, and how the concern about autism and vaccines is simply emblematic of concerns about vaccine safety in general. Read full post »

Why Doctors Fail To Change Behavior

Earlier this week I wrote a post about raising heart healthy children. The data summarized in that post may be the most important data I discuss all year when you consider that heart disease kills more of us than anything else. Thing is, I’m not surprised many of you haven’t read it. I expected it.

It’s just so flipping hard to read, or have any interest, or take advice about health when the advice or data requires us to make big changes. Or when the advice (regardless if we trust it or not) seems intuitive and self-evident. Things like eating less, restricting salt, or exercising more don’t sound so new. Those are things we already know we should do, but we often just can’t find a way to implement change in our totally overwhelming and busy lives. Big changes regarding how much we exercise, what we eat, and how we model behavior for our children seem daunting, overwhelming, and somewhat paternalistic. I also think it’s uninspiring to read about preventing heart disease in our kids because it feels so far off (thinking of our child dying of a heart attack or stroke doesn’t really compute) and really, we often can’t see heart disease. Heart disease walks around us silently.

That’s where we physicians fail, I think. There is convincing data about preventative health care that urges us to help get our patients to change behaviors that cause them suffering and ultimately threaten their life. But we fail to convince our patients to make changes because we simply don’t make it relevant enough. Or easy enough. Or we’re not convincing because we don’t demonstrate that we follow our own advice. Many docs are constantly trying to figure out what works best. See this tweet from Dr Pourmassina, an internal medicine physician in Seattle.

I think about ways to improve our translation of research for our patients all the time. And I think telling stories really helps. But I didn’t begin that post about heart disease with a story. Although there are many.

Last weekend for example, I set out to exercise every single day (without fail) for 30 days. I haven’t had time to prioritize exercise (let’s be honest: since F was born) over the last 5 years. And in my quest for 1 month of change, already I’ve failed. I made it only 3 days. And not for a lack of motivation; I love to run. Read full post »

Speaking Up In The Exam Room

I was in a cab yesterday afternoon. I’m at another conference this week and as I made my way to San Diego, I had to count on many people to keep me safe. From the pilot to the air traffic controller to the cab driver. We do this all of the time, of course–step into a moving vehicle, sit down, inform another person where we’d like to go and then just trust. Trust that they know how to drive, that they’ll take care of us, that they’ll do their best to remain aware, responsive, and agile in the face of unexpected events. We trust that they’ll keep us alive and return us to our children. We do this at the clinic and at the hospital, too.

As I sat in the back of the car, I noticed a sticker on the window describing the bill of rights for passengers for San Diego Airport cabs. The list detailed things I was due: a safe car, a working seat belt, a music-free ride for example. And the kicker, a driver who doesn’t talk on the cell phone.

Read full post »

Traveling For Work

I’ve been traveling for a week. Please forgive the silences here. As you can imagine, I’ve been making lots of noise elsewhere. Since I left my little boys and husband early morning last Friday, I’ve been at the AAP national meeting in Boston where I met with many friends and peers, gave a talk at a big conference at Mayo Clinic in Rochester, MN, had the honor to participate in the Mayo Clinic Center For Social Media board meeting, and today I’m speaking about immunizations at the Minnesota Dept of Health’s Got Your Shots conference in Minneapolis. All very exciting and this work and time feels productive on many levels but the leave-taking last Friday left me gutted.

O had been up all Thursday night last week vomiting and we spent the night in the frenzy of clean-up (how many back-up sheets do you have?) and comforting. As the sun rose, I knew I was leaving them for the longest stretch ever. I vividly remember the sound of the car door closing just as I drove away and it wasn’t until about North Dakota, mid-flight, that the ridiculous ache (heart) and nausea associated with leaving started to regress. It’s been busy since I left. The work serves as a very good distraction. But like many of you have heard, I often feel like I’m missing a limb or two when I’m away from my boys.

It was last night when I knew I needed to head home. The Husband mentioned that F had proclaimed it made no sense to travel to the farm (that we usually do) to get a pumpkin when he could simply get one at the grocery store. Clearly logical for a near 5 year-old. But the reason I knew it was time to head home was that my husband agreed.

I’m honored to work and entirely blessed to share my stories and my ideas about working as a pediatrician and writer and working to change health care. But it will never ever take away the role I cherish and hold most dear. That is, my commitment and love for my children and my family. The busier I get, the more clarity I hold. As I speak about striving for balance and making sense of the different hats we wear and batons we pass in our lives as parents and clinicians and children and community members, I must say that never once while away did I worry that I don’t understand priorities. The boys thrive as I do because I am surrounded by committed family and friends who share a similar vision. And they love and hold and care for the boys beautifully while I’m away. As I woke this morning across the street from The Mayo Clinic, what I knew was this: I can’t wait to get home to see those boys and travel to that farm for a beautiful pumpkin, but I really am thrilled to be here in Minnesota and just so happy to help.


We Can Engage With Grace?

Our kids teach us a lot about life. Doesn’t matter if they’re in-utero, a newborn, a toddler, or a teen. An obvious statement of course, but not only do our children teach us about their journey, they teach us about our own. Today it happened again, O taught me something. He reminded me about self. He reminded me about our need to be who we say we are and our need to perform at our best. When we don’t, it can unravel us.

It is our own disappointment in self that stings the most. I thought about this while reading Dr Atul Gawande’s recent New Yorker piece entitled Personal Best. To me, Dr Gawande’s courageous act of getting an expert coach exceeds his desire to better himself as a surgeon and beat the national averages on complications. He wants to stay true to himself; he wants ongoing improvement and escalating precision. He doesn’t want to let himself down. If we let others down, it feels absolutely terrible. When we let ourselves down by acting against our integrity or mission, it can feel far worse. Visceral. Two things converged on me today: Read full post »

Work Life Balance? Milk And Cookies?

After a great day in clinic yesterday, I was up until nearly 2am this morning tidying my email inbox, meeting some deadlines, and readying for a talk tonight on work and life and finding balance. The timing of this talk bleeds irony, I know. I also acknowledge I’ve already used up my one night allowance of sleeplessness this week– if you’re keeping score (see my most recent blog post).

Tonight, I’m presenting on behalf of PEPS about finding balance in our transitions back into work outside of our homes and finding peace with the juggle between caring and loving our children while finding meaning in our work. I’ll talk about disobeying the rhetoric/rules that others share about “work life balance.” I’ll talk about my experiences as a working mom, I’ll share lessons I learn from my patients, I’ll share some research, and I’ll discuss some tools you can use to improve behavior change.

If you want to hear a bit of my thoughts– or better– if you’d like to school me on how to make this all work, please join me. Tell me what you think and know. I expect, like so many experiences in my life, I’ll get a lot more out of this than I’m able to give. I’m told there will be milk and cookies, too. Incentive enough?

RSVP: PEPS Parent Talk Lecture Series


August Looked Like This

Here’s a window into the time I had while away from the blog this past month. I’m so thankful I took this break and spent so much time with my boys when outside of clinic. Unplugging has turned into the ultimate luxury…

Online Sabbatical

I’m taking an online sabbatical this month. Consider this an act of both self-reflection and self-awareness but also an act of self-preservation. As any blogger knows, blogging every few days, taking photographs daily, approving and responding to comments 24 hours a day (7 days a week), while authoring content in your head every few paces, is an entirely consuming experience. Blogging has completely changed my life. And this job is an utter privilege. I concur with a good friend from high school who has said, “I’m happy to help and thrilled to be here.”

But I’ve been consuming media, blogging, and authoring content without reprieve since November 11, 2009. That statistic is not a justification, rather an explanation. I simply need a bit of time away from this space. I need to understand the relationship I have with my iPhone, with Twitter, and my blog better. I need to go back outside.

I also need a bit more uninterrupted time with my children. I need some uninterrupted time with myself. I need to go to clinic during the week without being online for a few hours first.

Today, I’m stepping back.  I’ll be working in clinic. I’ll be working at home. But I won’t be blogging, I won’t be on Twitter, I won’t be checking comments every few hours.

My thought is that I’ll reemerge differently. I speculate it may be liberating. I speculate it might be stifling. I have no idea how I’ll actually feel. But I know it will help me understand not only our complex relationship with social networks and digital media differently, it will improve my capacity to share.

I will miss this community. I have come to count on all of you more than you know. I learn from this space daily. I’m a more-informed, better-read pediatrician because of this.

I’ve been given all sorts of advice about how to unplug successfully. That in itself illuminates the nearly universal challenge we have with our devices and our technology. Remember when I said I was a little bit unhappy?  When I unplug, I’ll trust my instinct and I promise to report back. In the meantime, I’ll dig up and re-post blogs from the past 21 months that you may enjoy. And I’ll likely post a few new photographs for you to see from time to time.

Until September 1st, I wish you all well. May you find a little more time to look at the sky, too…