Mama Doc Philosophies

All Articles in the Category ‘Mama Doc Philosophies’

Learning To Lose?


We spent a fair bit of our time on vacation last week playing two games with the boys: UNO and Spot It. Our son F is wholly competitive; he likes to know all the answers and he likes to win. He really likes to play and giggles when things go his way or when throwing a SKIP or DRAW 4. But he is also beginning to show how much he hates to lose. It turns out he’s rarely wrong about things, so not having things go his way isn’t really a part of his evolving schema. Thing is, he is also really polite. So when his behavior disappoints us, he takes things seriously.

After losing at both UNO and Spot It Thursday afternoon he began collapsing in the chair, throwing his excess remaining (losing) cards onto the table (or the floor) in frustration. After a second dramatic display, I’d had it. I told him he must sit out a game the next time we all got to play. I used the rationale, “Your friends won’t want to play games with you if you can’t celebrate when they win.” And, “Everyone playing the game is aiming for the same goal, we all want to win. Sometimes it just won’t be in the ‘cards’ for you.”

The next game he got to play was UNO and his grandmother won. He said, “Congratulations, Grandma. Well done.” He held onto his cards. He smiled. It was verbatim to how I’d instructed him. And I must admit, something about it didn’t seem quite right.

About 2 hours later the husband read a passage out loud to me from The New Yorker about Peter Thiel and his desire to win, stemming back to his math prowess as a child and his inclination for chess.

He became a math prodigy and a national ranked chess player. His chess kit was decorated with a sticker carrying the motto “born to win.” On the rare occasions when he lost in college, he swept the pieces off the board; he would say, “Show me a good loser and I’ll show you a loser.”

And there you are. A parenting perplexity. The question really is, do you want to create an obstinate-genius-winner or a good loser? I must admit, part of me really doesn’t know. But I’m certain there is something in between…

Ode To My Medical Assistant

I feel really connected to my medical assistant at clinic. The most incredible thing about her is she just “gets it.” She gets the pace of parenthood, the pace necessary to keep patient care moving in clinic, and the pace of my patient–even the very little ones and the big ones. She’s compassionate. She’s invested in being kind. She really treats children like children. When, for example, she doesn’t trust her gut on how a child is completing their screening vision exam, she’ll wait until end of the visit and repeat it. She’ll switch out letters for pictures, she’ll grab stickers to incentivize. This week, she was solving problems before I even noticed they were slowing us down.

She remembers patients like I do. The details, some health related, and some not. Glittery shoes, a nickname, a chronic ear infection, a mother’s need for extra time, a worry that a parent repeats. She says things like, “Did you hear about Angela’s CT at Children’s”" randomly on a Thursday two weeks after we last saw Angela.

She worries like a mom. She performs like a professional. She calls children by their name.

Not everyone in health care delivery is invested in what matters most. Unfortunately, it can be very easy to lose sight of patients in health care, however bizarre and inane that sounds. And so it’s an utter privilege to work with my MA. But more, it’s just so nice to have such an incredible partner. It’s, of course, teams of people that care for patients, not just doctors and the nurses you see. But teams of receptionists, labs techs, schedulers, assistants, insurers, leadership, specialists, nurses, generalists, and so many more.

Teams are good. But sincere, tactile partnerships change everything. Sometimes I feel very alone in my work–right now thanks to my MA, I don’t. To you, Katie, I say thank you so much for making 2011 far better and for all of the hope you bring to 2012…

Pee, Patience, And Parenting At 35,000 Feet

Recently while on the plane, O wet his pants. Lovely really. He’d refused to pee prior to getting on the plane. Refused to pee at home. Essentially, O refused to pee “on command.” No surprise for a strong-willed-spirited just turned 3 year-old. And after he wet his pants, he then proceeded to have about 14 accidents (yes, I’m exaggerating) later that same day as we traveled to his grandparents’ home. Instead of being patient, supportive, and perfect, the husband and I realized we were just plain-old disappointed. And full of judgment.

Potty training takes patience, perseverance and a positive attitude. Many days we don’t have all three, all at once.

O had mastered his potty-trained world well over the last month or so and the wetting accidents weren’t on our to-do list. He’d been dry all day for a number of weeks. The frequency he was wetting on that particular Wednesday coupled with the inconvenience of it being a travel day just wasn’t my pleasure. Although he’d delayed pooping in the potty for a few months (also totally normal but uber-frustrating, too), that had all resolved some months back. The accidents felt like an inconvenience. And although as a pediatrician, I know how to lend advice in this area, it’s the taking advice part that is more of a challenge.

After age 3, when a child shows resistance to using the potty the “right” thing to do, is to carry on with a smile, stop providing reminders for your child, show that you’re unflappable and continue to praise success. Ignore potty failures, praise potty success.

But it is a seriously difficult task at 35,000 feet when surrounded by pee. Consequently, we spent part of the holiday nudging each other about how terrible we were and how we needed to move from D&J (disappointed and judging) to P&C (patient and compassionate).

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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 »

Getting It “Right”: Birthdays In Mommyland

My quarterly crisis is rearing its very ugly head. See, it’s birthday season around here and while the boys’ birthdays overlap with the holiday season, I tend to feel an irrepressible need to reflect. Holidays and birthdays are momentous moments, but also markers of time. Places on the calendar and spaces in my heart for subscribed reflection and perspective gathering.

So it is now, this time of year, where I seem to struggle the most with my choices as a mom and a doctor, a wife and a daughter, a community member and a girl just trying to get it all “right.”

I cry every year on my boys’ birthday. The tears well up both out of joy (wow-wow-wow my little boys love getting older & their joy with the special day grows annually) and also out of sadness. Sadness in my ongoing strife with the question of shifting balances, purpose, goals, and daily mindfulness. Am I working too much, am I missing something, am I as present as I can be? Should I be home more? Should I contribute and write more? Should I be seeing more patients? Can I help more people than I am helping today?

I’m torn. Shred up about what is “right” (for me) and on birth day, I’m nearly emulsified. This is tough stuff. As the years tick by and the acknowledgement of mortality grows as the days seem seep into the ether, I really want to have no regret. Sometimes, like most humans, I do.

Part of the trouble is the words of all the parents around me. They all say the exact same thing. And they have been saying it to me for over 5 years. I know they say it to you, too. The woman at the grocery, the mentor or peer, my good friend, the doctor across the country, the parents in my clinic, my mother, the barista, the man helping me at the parking garage…. They all say the exact same thing when they see my boys:

“It just goes too fast.”

 

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Happy And Thankful

Happy and thankful. The holiday served up a great reminder. Time offline, outside, and away from work is absolutely priceless. We should use all of our vacation time. We should fight fiercely to protect it. Thanksgiving reminded me that I am just so happy and thankful. For the holiday, we traveled to see F & O’s grandparents and the boys had some real deal time with their cousins. We played with a lot of balls (tennis, basket, bocce, foot). Little did I know that having two boys would ensure a deluge of round things.

We went to a high school football game an

Pediatricians Who Refuse Families Who Don’t Immunize

I just responded to a New York Times “Armchair Ethicist” chat about pediatricians who refuse patients who don’t fully immunize. I realized my comment on their site belongs here on the blog. (my comment is number 79 but also copied below).

What do you think about pediatricians who refuse patients who don’t follow the AAP schedule? Do you disagree with me? Would you be more comfortable seeing a pediatrician who refused those families who chose not to immunize to protect your children? Have you, or someone you know, ever been kicked out of a pediatrician’s practice?

I’m a pediatrician (w a master’s degree in bioethics) and mother to 2. I will always keep my practice open to vaccine-hesitant families. However, the waiting room risk (unimmunized kids & risk to vulnerable populations–ie infants, those too young for vaccines, and immunocompromised children) is a good one and the only compelling reason to close to patients who refuse immunizations in my opinion.

But it’s not a good enough reason for me to send families away who have questions and hesitations about the AAP/CDC schedule. All children deserve a pediatrician versed in immunization benefit/risk & deserve an expert in conversation w their parents to foster insight & understanding. Frankly, if waiting room risk is the concern, there are ways to create separate waiting rooms for kids “up to date” and kids who are not.

Great thing is, only about 10% of families use alternative vaccine schedules. In a recent Pediatrics article, only 2% of families who used alternative schedules refused all vaccine altogether. So although this is a large issue in pediatrics and parenting, the majority of families do vaccinate on time or nearly on time. I don’t want to lose sight of that.

I practice in WA State. We lead the nation in exemptions for vaccines (over 10% of kids w exemptions vs only 2% nationally) and have recently put into place a law that requires families to consult with a health care provider prior to an exemption. It was designed to avoid exemptions out of convenience. This hopefully opens up the opportunities for discussions with parents & pediatricians!

We all want the same thing: healthy children, healthy communities. Fostering conversation and diminishing a context of “war” or opposition about immunizations is an important step. In my experience, most parents end up immunizing their children over time even when they start out as refusers. The group of full refusers is fairly small. So allowing all kids into my practice feels like a great opportunity.

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 »

The Saturday Box

We’re all looking for little tidbits and rituals to insert into our busy lives that actually help in that quest to have life run smoothly. I suspect The Saturday Box is one ritual worth considering.

I’m not saying that my parents did it all right (ahem….no), but circa 1983, I think the Saturday Box exceeded expectations. Our box inspired a sense of greater responsibility and established a democratic process for clean-up in our home. Less fighting, less let-down, less guilt, and less tension. More responsibility, more ownership, and more order. The genius: the box wasn’t just for my brother and me. Plenty of parental-garb ended up in our Saturday Box and the concept alone invoked a sense of equality. Not unexpectedly, we were occasionally feisty; I have a very clear memory of a family meeting being called after my father’s wallet landed in the Saturday Box….

Watch the video about the Saturday Box. What do you think? Have another successful tidbit to share? Will you do this and report back?

Halloween: Wicked Scary Tantrums

I like Halloween far more as an adult than I ever did as a child. At least that is how it feels now. Witnessing the excitement this year around casa Swanson has been a hoot. Not all easy though. Like I have mentioned before, holidays come with all sorts of novel stresses that our children experience differently. Then mix in a whole bunch of costumes and candy and…imagine.

On Friday, our little O had a mega-tantrum at the preschool parade. So loud, so ornery, so insistent that he never donned the costume and never got near walking in the parade. The tantrum ended only after arriving at home. I was feeling entirely terrible already as I was out of town and unable to make it to the parade, but when the husband called me at the airport and told me it was better that I wasn’t there after all, I felt even worse. The Mama-ache reached new heights. Although I mentioned that day one of preschool was a heroic moment, days 2 through 25 have been (typically) different.

Tantrums are wicked-scary-terribleness sometimes. The public grimaces, and then points and whispers and stares and judges. Our children’s friends and peers run the other way. And we parents look like out-of-control-bats. Tantrums can be very Halloween, actually. A post on the New York Times Motherlode blog yesterday couldn’t have come at a better time. Read full post »