I had a phenomenal day in clinic yesterday. Imperfect for sure but inspiring, connected, and busy. I felt useful and like anybody else, that feels so good to me. Productivity can be defined in various ways and yesterday I fulfilled my personal definition. I wrote an email to a friend and cardiologist this morning where I said,
But I must say, it’s a sincere fortune to be a doctor some days. Yesterday was one of those…
It was typical day in the sense that my schedule was crammed full of well child check-ups, newborn visits, and a few scattered visits for acute care–colds, depression, and belly pain. As is typical, I arrived in the morning with absolutely no open spots on my schedule. I saw 25 patients, squeezed in 2 patients to “double book” who needed to be seen by a pediatrician more urgently, and we provided vaccination updates for over 1/2 the patients. The “productive” feeling washed over me a number of times. At one point a mom said, “I knew that but I just needed you to guide me to know that I was right.” Another moment when I confirmed the correct diagnosis for a patient who’d been into doctor’s offices twice where the diagnosis had been missed. It’s exhilarating to help people understand health, highlight their understanding of science, and calm them down. Parenthood can be extraordinary (understatement of the century). The best part of my job is when I can help clear off the windshield of doubt. I do want parents to see the road…
But the day wasn’t perfect. Read full post »
Every once and a while I make the right choice. I mean when it comes to work and life and striving for balance. Sometimes I say “No” just when I should. Those “No’s” gain access to the best “Yes’s” in life.
Last week at the end of a series of 3 weekends of work, I was finishing up a conference and decided at the last minute to decline the dinner with peers. I felt pressure to go but just couldn’t stand missing out on the night with my boys. I had that longing in my heart–you know the kind–where you can feel the ache of absence, where you sincerely feel the separation from your kids like a missing body part? It was strong; all at once I said “No,” just in time.
We went to a baseball game here in Seattle. We sat only 8 rows back behind the dugout. The foul balls flying near our heads (me ducking for cover), the crowd screeching, and the sky blue. The husband and the boys had their gloves. We counted airplanes flying above. We cheered and jumped up with home runs. It was a perfect night out. Delighted to be there I had these passing waves of mindfulness, or gratitude, for being with my family and not missing out once again. We were all a little giddy to be at a real baseball game and then 2 things happened that affirmed my “No” was really a magical “Yes” afterall:
- A teenager caught a foul ball. Then he caught another ball. Then he did what many kids do—he acted generously. He saw F sitting right in front of him with his glove up and he tossed him the ball. I mean, can you believe that? A teenager gave my little 5 year-old boy a Major League baseball…bliss.
- During the middle of the sixth inning, after a bag of popcorn, a small tantrum from O, a bag of peanuts, and 4 hot dogs, Pennington went up to bat. Jon leaned over to F and said, “This guy’s hitting a ball to us.” They got their gloves up and ready. The foul ball did come. And the husband really did catch it. And my boys (all 3 of them) really did leap up for joy. We even made it onto TV (see photo above)!
Two foul balls, one perfect “No,” and a Saturday night with my boys illuminated a momentous “Yes.” It doessn’t always work this way yet every once and a while we make really good and really lucky choices. And then we’re fortunate enough to witness and celebrate them while they happen. For all the suffering that remains in so many of our lives, these little spots of light must be spoken…
Sometimes TV is really good. We pediatricians forget that every time we advise against television-viewing using restrictive language. Yup, there’s a lot of bad television. And yup, there is good evidence that TV doesn’t do your baby’s brain any good before age 2. And yes, there is also evidence that what your child watches on TV matters. Yet every once and a while, we can be reminded of the magic in beautiful cinematography. And we can feel the bonding that arrives from the shared experience of traveling around the world (from the couch) while at home watching public TV.
I love this New Yorker article by Emily Nussbaum: It’s Good Enough For Me. She describes the drill (how we all are supposed to report our hatred of TV) and how she’s found a bit of beauty amidst the “renaissance of children’s programming.” There is something to be said for moderation when it comes to nearly all things in life…
When I grew up we had about 6 channels and with the current 600 channels to peruse I wouldn’t suggest the content is any more compelling. But tonight we had a mesmerizing night watching a show about dolphins and whales called Deep Thinking– how they communicated, how they empathized, how they think, and how they grasp their sense of self. It happened by accident after the boys had watched an episode of Bob The Builder. We were jumping off the couch heading for books and bed when Nature came on. It was the scenes from the Serengeti that caught my attention. When the images advanced to the ocean and the dolphins started to squeak, we all sat back down.
The boys stayed up 1 hour past their bedtime. We snuggled under the covers. O pretended to be a whale. F stared.
Imagine four of us in front of the screen, eyes wide open, sitting in stillness for an entire hour bearing witness to the intelligence of dolphins and whales. The show schooled us in geology, biology, communication, and the incredible beauty housed underneath the surface of the water. The boys talked about blow holes, fins, squeaks, and sea grass. They watched a sting ray detect an octopus in the ocean floor. We saw dolphins delight while playing with rings of bubbles. We learned about camaraderie under the sea.
So, should you have a television in your child’s room? NO
Is television all bad? NO
After a terrifically insane day the best moment I had was amidst those images of the sea, my boys nestled tightly into my side, while the clock ticked well past bedtime. All thanks to TV.
I took 24 hours offline from Friday at sundown through Saturday at sunset. I didn’t use my phone, I didn’t text, I didn’t log onto a computer, and all the while I didn’t enter a single network. I didn’t blog, tweet, Facebook, or LinkIn. I was genuinely unplugged without entering the wilderness. I was at home in Seattle devoid of my devices on my second annual digital sabbath.
I went shopping for a friend’s birthday gift by myself, the quiet liberating. I went to a baby shower, I played baseball with the boys outside, I cleaned up the back yard. And while the sun shone in Seattle on Saturday afternoon, F and I cuddled on the driveway. We laid down on the pavement and looked up at the sky. We didn’t talk much and even with the paucity of words, the moment takes up a big part of my long-term memory. Little F returned twice to join me on that hard surface, grabbing for my hand amidst the concrete. Presence is very soft no matter how hard the earth below you.
No beeps, dings, or directories distracted. It was a day much slower than the rest.
The lesson is simple of course. Twenty four hours without distraction are exceptionally bright. The loss from being disconnected online is overwhelmingly surpassed by the gains acquired with being present offline. And although it’s easy for many of you, this unplugged time is an utter luxury for me in the time of exceptional connectivity and work online.
There’s nothing I would do to reverse my time offline. It was rich and it’s solidified the need to establish a new goal to make time for a more frequent digital sabbatical. I want to seek solace routinely from the deluge of content, information, exceptional wisdom, and friendship I gain while online and return to the spaces without distraction that house the same things.
Join me? Will you take earnest 24-hour periods of time without technology, too? Do you think your kids will notice?
Sometimes health education comes outside the textbook or the hours required in medical school. On the plane this week I tripped on an extension class–a movie.
A movie every doctor, daughter, son, mother, father, dog owner, and caregiver should see. I’ve never recommended a movie here before but this one I consider a must-see. It’s R rated, just like health care. And parenting.
There is a lesson every few minutes. Here’s 8 I saw:
- Medication is incredible. 70 years ago yesterday patients started to survive from previously incurable illnesses by using penicillin. When you’re giving a father or a mother or a daughter or a partner medicine, put it in a beautiful cup. It may improve the experience. Half way through the film, you can see examples. Providing reminders and offering mediations can sometimes be beautiful.
- When you’re a doctor, remember that your tone and every single word you chose can have lasting power. Not always (thank goodness) but sometimes. Listen to the doctor provide the diagnosis (even in the trailer below) and pause on the power of that particular metaphor. Metaphors and images can serve your patients beautifully. Or haunt them, too. I remembered listening to a voicemail from a doctor in 2004 over and over again. I wanted to hear the good news but all I kept hearing was the truth: the bad news. I listened to that doctor’s voice again and again. Chose your words carefully as best you can when providing news.
- Sorrow and mindlfulness in grief and anticipation of loss can create great meaning. Presence in our reality is a gift for being human. I can’t remember who said this to me recently, but I keep thinking about it: being a caregiver to a suffering or hurting individual may be the most meaningful experiences you have while living. Beginners reminds us we need no medical training to nurture and relieve suffering. Read full post »
When I was a medical student and resident physician, those around me taught me how to distrust the pharmaceutical industry and how to distrust the insurance companies. The drug companies just wanted the public to buy their medications (to get rich) and the insurance companies just wanted to block services for my patients (to get rich).
The more I learn as a physician, the more I realize how little I know.
The great thing about the extensive travel I’ve been enduring lately is that I learn to see the world differently. This week I participated on a panel at SXSW (called: A Dr, Patient, & Insurer Walk Into A Social Network) where I had the opportunity to share my thoughts as a doctor alongside a patient advocate/technologist and an insurer.
The technologist sees the world like this:
We envision a world where information exchange between patients, doctors, pharmaceutical companies, researchers and the healthcare industry can be free and open; where, in doing so, people do not have to fear discrimination, stigmatization or regulation; and where the free flow of information helps everyone. We envision a future where every patient benefits from the collective experience of all, and where the risk and reward of each possible choice is transparent and known.
The Insurer sees the world like this:
We believe we can help create a better health care system. This belief drives our daily decisions as one of the nation’s leading health care benefits companies. We work hard to provide our members with information and resources to help them make informed decisions about their health.
Read full post »
I loved a recent NYT article where Dr Eric Topol described Americans as surgically connected to their phones. He also described the great opportunity that resides within the phones for getting and providing better health care. These phones are a part of our future and can be exceptional partners in measuring and preserving our wellness. These mobile devices and apps will increasingly put the patient at the center of their own care. Dr Bryan Vartabedian summarized Dr Topol’s book and reminded us that, “medicine is increasingly anchored by the individual.” Thank goodness.
But the balance of how we value and use these astoundingly powerful pocket tools remains mysterious for some of us. There is a growing body of work about the addictive properties of smart cell phones. And although I hear a lot about how we should advise our children and teens to manage their digital device use, I don’t hear as much about how we as parents can do the same.
There are countless blogs and loud rants that cross my desk (phone, I mean) shouting for moms and dads to get off their phone when they are with their children. They look a lot like this:
Now Mr Palmer wasn’t yelling at me this morning (or maybe he was), rather he was responding to some data I shared about cell phone use: 1 and 3 adults say they frequently use their cell phones at the dinner table. Read full post »
For the last month or so O has woken up every single morning with the same question:
“Is today a Mommy Daddy Day?”
What he means is, “Is this a weekend where I get the day with both of you?”
The answer, less than 2/7 of the time, is unfortunately “No.” And on some level it kills me. I don’t usually only say, “No” when he asks, I usually end up marketing the day. It goes something like, “No, but the great thing is today you get to go to school and you have swimming lessons. Or, “Today you get to go to the zoo with the nanny and make thank you cards. Or, “Today is a Daddy Day!”
It weighs on me. O is extremely attached and has been since day (before) one. I often think about how he’s as attached as I am. F on the other hand adores his independence.
I traveled all week and fortunately mid-week from Florida I face-timed with the boys. It was delicious really, and settled my aching heart in spite of the fact that the first thing O said when he saw my face was, “Come home, Mommy!”
Being a working parent tugs on us in bizarre ways. But it also elevates us. And as I spent the week crossing the country giving lectures, I was reminded of my strong sense of purpose. My need to speak up and improve the world for my children. The need to scream from the roof tops about revolutionizing health communication. I mean what I say and I believe in what I do. And while the boys thrive, this equation of clinical responsibility and working to change health care, works. The only problem is that this week O might have missed me as much as I did him. I would suggest this new reality is not entirely ideal.
Read full post »
I had a great trip to the grocery store today with the boys. Life has been so hectic these past few weeks, we haven’t had weekend time for a leisurely trip to the aisles of fruit and fondue. Today, we had the luxury of time, a list, and a proper plan. They weren’t hungry (and neither was I) so our stomachs didn’t drive the cart and the boys were uniquely engaged. We perused the produce area. We made peanut butter in the machine that crushes raw peanuts. We talked about some of the beginnings of the food we bought (the avocado came from Mexico, the mini-oranges from California). But I thought most about how pleased I am when I end up at checkout with more fresh food in the cart than food stuffed into packages. Today I think I came close.
And that’s the lesson. One thing I say over and over again in clinic is, “If at all possible, for every single meal you offer your child at home, make sure 1/2 the plate is covered in fresh fruit and veggies.”
So if that’s the goal, the cart should always look the very same way.
Stop what you’re doing to read this The New England Journal of Medicine perspective by Dr Doug Diekema. It’s about vaccines, opportunities for health, and physician obligation. Written for physicians, it also speaks loudly to parents and includes a few very essential points. The whole time I read the article, my thoughts kept leaping to our imminent opportunities. Today, in 2012, we can harness the tools of social media and technology to solve many of these problems. It’s time. HPV vaccine? Varicella vaccine? Remember your yearly flu shot? I really think there could an app for that.
Let me explain.
Dr Diekema opens describing a scene very typical in Seattle.
Recently, the mother of a young child confessed to me that she didn’t know any parents who were following the recommended immunization schedule for their children. She said that when she told her pediatrician she’d like to follow an alternative schedule, the physician had simply acquiesced, leading her to assume that the recommended schedule had no advantage over the one she suggested.
Yes, the physician obliged her desired schedule for many reasons, I suspect: time restraints/desiring a partnership/a hope for future opportunities to provide education and update immunizations for the child. In a state (Washington) that leads the nation in vaccine exemptions, we encounter patients daily who prefer a delayed or personal schedule. I’ve written about parents and alternative schedules and physicians’ conditional comfort with alternative vaccine schedules. But when Dr Diekema mentions this family, he highlights what many pediatricians and family physicians realize: families may be clustered together in vaccine-hesitancy. Friends of friends instruct each about vaccine schedules and share beliefs about safety. We know that 40% of parents who use an alternative schedule create it themselves.
Family members persuade my patients not to get immunized. Even in the midst of a pertussis outbreak in the county in which I practice, grandparents and relatives of newborns refuse the Tdap vaccine. My patients are bombarded with advice and naysayers. Who we love (friends and family) and who we trust (friends and family) certainly affect what we do. My patients get confused. And most of health (care) conversations happen outside the exam room. Therefore, hesitancy clusters in neighborhoods naturally and poses regional risk. What if we had real time information about our schools? About our neighborhood? What if Google mapped our rates of protection from vaccinations? What if we had a smart phone app that provided us yearly data on school immunization/exemption rates when we selected a kindergarten? Why not an app for that? Read full post »