Mama Doc Philosophies

All Articles in the Category ‘Mama Doc Philosophies’

Cell Phone Parenthood

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 »

Mommy Daddy Days

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.

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Half & Half

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.

An App For That?

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 »

What About Chores? Seattle Mama Doc 101

So what about kids and chores? My take is that it’s personal. But also I’ll hint that I think chores are a great opportunity to build community and citizenship. Research has found great lifelong reward from doing childhood chores (think: less drug use, higher self-esteem, more sound relationships, beginning a career path, less anxiety, etc). I mean with those findings, sign me up! But it’s possible not everyone agrees and research may not be what sways you. It may be a need to get things done around the house. A popular poll (done way back in 2001) found that 75% of people feel children do fewer chores today than 10 or 15 years ago. I don’t know if that’s just recall bias or pessimism or favorable historians talking. But…

A smattering of opinions about chores:

What do you think; is there controversy here at all? Do you think chores help transition our children into responsible adults?

To Make Time Stand Still

It would be nice–every once and a while–to make time stand still. To catch the blades of a propeller mid flight and have the ability to hover effortlessly.

Just for a moment so that we could look over, savor our children…their beauty and all that they are all in one precious moment…all to ourselves. The march of childhood moves quickly. And what a thing to be weightless and into the air without the distraction of aging and the ticking clock of time. Innocence preserved, our unconditional love packaged, and our children just as they are. Because we all know tomorrow will look different. To get them in a gasp of time, beautiful and unique, even if only for a moment. Wouldn’t it just be so nice–every once and a while–to make time stand still?

Snow Day

It’s a snow day. Snow day is a word combination in the English language that has two meanings, divergent and separately defined only by age. To a 5 year old–“snow day” sounds a little bit like “Nir-va-na”–a day that is one of life’s greatest gifts. To a 37 year-old with a few jobs, it sounds a little bit more like “stresssssss.” Snow days, of course, often leave us without child care, without a school system, and without a back-up plan. And when our work doesn’t stop, we’re left juggling a set of very cold knives.

It would be nice to exist in a culture where snow day meant the same to all of us—a perfect reason for a big gasp in the productivity machine. Play and a little more unrestricted, unscheduled time outside is good for all of us. But that’s the onerous and stark reminder we get on days like today: we really are grown-ups and there is work to be done. And since snow days aren’t a national phenomenon, those of us that collaborate with others outside of our community, “snow day” sounds a little like a fake cough when it comes to an excuse for extending a deadline…

Don’t get me wrong, safety should always remain a priority. We should fiercely protect our children from driving and walking on roads with moving traffic when it’s icy and snowy; we should stay off roads when we are urged to do so. I’m not saying schools and routine businesses shouldn’t shut down. I think we need help juggling and understanding the multiple demands on our attention even when weather intervenes. We need a plan. Our work doesn’t stop demanding our attention and sometimes our bosses’ priorities aren’t aligned with our own. Read full post »

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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