‘doctoring’

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Emily’s Entourage

EmilyThis is a guest blog from Emily Kramer-Golinkoff. I was lucky enough to meet her about a year ago & even luckier that she asked me to help her make a big impact with her final thesis for her Masters in Bioethics. Her story, insight, and strength are worth your time. She’s hoping to leave a big mark in understanding how to leverage the asset of empowered patients to advance science and healing. She’s working to integrate patient communities more intimately in the health system. Her post is about why she chose to be an empowered patient and it’s fairly clear why she’s attracted an entourage…

Truth be told, belonging to a disease community isn’t my clique of choice. An artist community, a running club, even a yogi enclave sound more appealing. But I’ve learned that when our hands are tied, we’re better off building muscles in our legs than spending all our energy trying to wrangle our hands free.

That’s the philosophy I’ve embraced as a 28-year-old with big eyes, a bright future, and an advanced, incurable and fatal disease called Cystic Fibrosis. Cystic Fibrosis (CF) is a progressive genetic disease that primarily affects the lungs and digestive system. It causes thick mucus to build up in the lungs, leading to life-threatening infections.

My winding path to patient empowerment started as a headstrong, sassy little girl who clashed with my pediatric CF clinic’s authoritative culture. My perpetual questions of “why?” and efforts to integrate my disease into my life were met with disdain and labeled “difficult.”

Read full post »

Mindful Parenting

mindful and the skyThere was a moment, just after President Obama was sworn into the office earlier this week, that I’ve been returning to in my thoughts relentlessly. He turned amidst the regal archway of The Capital and stopped. His accompanying family and tribe of lawmakers waited. He said something like, “I want to take a look one more time.” And then he looked back upon The Mall and seemed to take it all in. A few seconds, maybe 1/2 a minute or so. Not long, no, but the moment seemed to take up enormous space. Quietly, eyes wide open, he looked out to the millions that had come to celebrate and bear witness to his honor and his responsibility. Instead of looking at him, my eyes migrated to his daughter, Malia. I saw her watching.

It may have been mindfulness.

It’s of course never clear to an outsider who is mindful or not. Thinking and spending energy to be more present is a passtime that I was introduced to as a medical student because of the work of Dr Jon Kabat-Zinn. I use lessons from his work in my personal and professional life on a daily basis. Therefore, it was a sincere joy last night to sit amidst 1000 other parents and hear Jon Kabat-Zinn and his wife Myla talk about, “Mindful Parenting.” I was surrounded by my husband and friends, many colleagues and pediatricians, and I was lucky enough to sit near parents of my patients. It was community. To me it felt like a needed touchstone and a hearty reminder of how nicely being mindful fits into a busy, reflective, hectic, and imperfect life.

5 Lessons From Kabat-Zinns On Mindful Parenting:

  • Mindfulness is not the antithesis of anything. There is no single ill or evil that impedes it. In fact, the last question on the night from the audience begged The Kabat-Zinns to detail the biggest obstacle to mindfulness. They couldn’t answer it really. All this, precisely because mindfulness in its simplicity is openness, compassion, and love. At the opening of the talk, Jon helped us recognize the work that it took to bring us there, amidst the heavy Thursday raindrops, rush hour traffic, busy workweeks, needy toddlers or teens at home, and the truth that there was potentially something else we really should be doing. He reminded us all that is was LOVE that had brought us together to listen to ideas about mindful parenting. This we all share. This is why mindfulness is possible for everyone at every time in their life. Each new moment is evolving into something entirely new.
  • At one point, Dr Kabat-Zinn looked down at his watch. At first glance it appeared he was tracking the timing of his talk and then he burst out, “If you check your watch, it’s now again.”  A hilarious reminder that each and every moment that unfolds is always now. We have a chance to bear witness to time indefinitely. We are offered up the opportunity to be mindful, open, and present with an infinite number of “do-overs.” Oh, wow–it’s now again. Myla furthered this saying, “Every moment is the possibility of a new beginning.” Every single moment is a new chance to be aware. Read full post »

Have You Been In To See Dr. Google?

Screen Shot 2013-01-15 at 9.45.29 AMFor practicing physicians, there’s a tricky balance in believing that the internet can help save lives.

I’m a doctor who encourages families to look up health info online and one who believes technology will afford improved partnerships. Yet, when we’re in the old-fashioned exam room, there isn’t always a place for the internet. Many clinics block video-streaming sites and don’t allow for traditional email exchanges between clinicians and patients. It’s hard to “send” patients information discussed during the visit. In the 10 or 20 minutes we have together, time is precious. Truth be told, health care remains wary of doctors and patients communicating when they’re not in exam room. Most insurers won’t reimburse or pay for electronic communication between patients and their clinicians. So doctors are often forced to bring you into the office to provide expertise. New data today may help change this paradigm. Reality is, many of us are using the internet as a tool for health care.

For at least 1/3 of American adults, the internet is a diagnostic tool

Yet, it’s not just insurers who may be wary of online info. Recently I read a patient review (online) from a parent who was frustrated I’d encouraged them to read the content on this blog. The comment implied that perhaps I was “pushing it.” And that’s the tricky part–when I first started writing this blog I was bashful to mention it in clinic. I wanted patients to feel comfortable NOT pressured. But now that I have over 350 blog posts showcasing research and pediatric health information it’s tantamount that I share it.  I mean, if I’m in the midst of a 15-minute visit and we touch on topics like getting a carbon monoxide monitor, the choking game, the Tdap shot, and the effects of TV on their kid’s developing brain, how could I not augment a parent or teens’ understanding by offering more information online?

Numerous studies find that what parents learn in the exam room with doctors isn’t retained. That’s where Dr Google comes in. Read full post »

Renewal, Intent, Intimacy, Reflection

Screen Shot 2013-01-04 at 12.36.15 PMI’ve self-prescribed a year of renewal, intent, intimacy, and reflection for 2013. Although I’m unable to etch those 4 words onto my forearm, I’d really like to keep them at the helm. Resolutions are exceedingly difficult to maintain. The bar is often too high, there’s little trigger to make a desired behavior happen every day, and the resolutions we choose typically demand profound change. I learned much of that from BJ Fogg and because I believe in his model, my 2013 resolution will have the aforementioned 4 prongs: renewal, intent, intimacy, and reflection.

This year, I’m easing into these resolutions by gradually making changes to how I work and how I live. I spent the end of 2012 bearing witness to our limited days on earth, reaping the bounty of commitment that family and friends give me, and sorting out my own role as a caregiver, writer, and advocate. However obvious it is that life is precious and limited, there are the rare instructive days in our lives that preach it to us. One for me unfolded in August. Read full post »

Greatest Hits 2012

Screen Shot 2012-12-31 at 10.47.01 AM

I give thanks every day for friends, mentors, teachers, collaborators, and family like you. It’s been a sincere privilege to share thoughts here. I’m always amazed at the depth of reflection that washes over me as the year comes to a close. However pre-conceived this day seems for reflection, today has me in its grip. The end of 2012 is filled with far more information about being a parent, being a patient, and being a pediatrician than the beginning held for me. More on that tomorrow, but for today I just want to say thank you for reading.

Here’s a list of the “greatest hits” of 2012. The list is based on the number of views and shares but also the impact these posts had on discussions about pediatric health and parenting. One post is included primarily on the number of people who went out of their way in person to discuss it with me. Please accept my sincere thank you for your insights, reflections, contests, partnership, and loyalty to learning and growing into parenting and pediatrics with me.

May you welcome in a beautiful, healthy 2013 tonight.

2012 Mama Doc Greatest Hits

  • TIME Magazine And The Mommy Middle Road This is a reaction/reflection to the TIME Magazine cover with a preschooler actively (potentially) breast feeding while standing on a stool. It’s about motherhood, finding confidence in our choices and knowing that yes, of course, you’re Mom Enough.
  • 4 Reasons Toddlers Wake Up At Night A list of reasons toddlers awaken their parents at night and 100+ comments/explanations for parents seeking the solace of a good night’s sleep. Read full post »

McClinic? Drive-Thru Health Care

I can’t stop thinking about a drive-thru. Not the one for burgers and shakes but the one for ear checks, sports forms, quick med refill visits or a lingering rash. For those things you just want to know fast or need done now, but don’t want to spend 2 hours resolving. For those things that really make you worry as a parent. Instead of the millisecond-mall-type clinic, we all want our doctors, our clinics, and our child’s team to provide health care. In my opinion, parents and pediatricians both believe in the medical home.

McClinic?

Imagine if you knew your doctor did the drive-thru on Tuesday afternoons. Would you swing by to ask about that rash you’re worried about or to check in on your child’s ears? Follow up on a new seizure medication? What if it didn’t even require a call ahead of time? What if tight time restraints were agreed upon (say 7 minute visits or so) in advance so the patient/physician agenda was aligned? Swing by on your way to daycare?

We want quality, trust, and mobility when it comes to health care. We want easy access, too. Of course we must fight for improved electronic visits and online advice. We want comprehensive, compassionate preventative care. We will need in-office visits, yes. And sometimes we need hands-on more urgent care, too. Now the “kwik-clinic” idea isn’t new, I know. Even hospitals are opening urgent-care clinics throughout the country. But your pediatrician often isn’t involved.  So what about that drive-thru: Read full post »

‘Having It All': Stumbling

I read The Atlantic piece written by Anne-Marie Slaughter entitled Why Women Still Can’t Have It All this past week. Make sure you block off a 1/2 day from work if you want to read it. It takes a good number of minutes to get through and I found myself kind of staring at the wall after I’d finished. Slaughter does a beautiful job spelling out the glaring issues of our time for working women using her intense personal experience and her extensive education. She lays out her thesis for our inability to “have it all” as working mothers circa 2012 and she illuminates the traps so many of us stumble into as we work and raise our children. Yet knowing all this didn’t really help in the immediate.

Differing gender roles, division of responsibility issues at home, and the juggle (tug-o-war) many women feel with balancing the needs of their family and the needs of their careers aren’t new. But Ms Slaughter does draw us in. I haven’t had a chance to chat about it at any water cooler, but I have watched and listened and lingered online. The article was a huge success for the magazine; even my husband notices a dust cloud at work. A ripple in the lake of life for many of us, for sure.

Let me break down my response in a few chunks. This isn’t exactly steady and linear for me. This isn’t a thesis or rebuttal either, just a reaction. Read full post »

Affordable Care

It’s hard to write about anything else today with news from The Supreme Court: the decision to uphold the Affordable Care Act. As a pediatrician and mom this isn’t about politics for me. It’s about the assurance that pediatric patients (my children included) can get the care they need. And that we work to make care affordable. Below are a few thoughts & quotes that have helped me understand how the decision will affect care for our children in the United States.

First off, more children will have access to health care. Children will maintain insurance for longer periods of time. And children who have congenital and chronic health conditions won’t lose their care. The majority ruling preserves key child health provisions including the law’s protections against pre-existing condition exclusions. Dr Robert Block, President of the American Academy of Pediatrics said:

Since the Affordable Care Act took effect, millions of children with pre-existing conditions gained health care coverage; 14 million children with private insurance received preventive health services with no co-pay; and 3.1 million more young adults gained coverage through their parents’ plans. These are just a few of the law’s investments in child health, with many more set to take effect over the next few years as affirmed by today’s decision. Read full post »

Every Illness A Love Story

One magical thing I see while working in health care is the love story. Each and every child who encounters a diagnosis or illness spawns a collection of love stories around them. The stories come spontaneously from parents, siblings, friends, nurses, doctors, community, and peers. It all happens organically and sometimes it happens without notice. Babies cling to their parents when they ache; parents cling to their children when they worry. And the acknowledgement of mortality can stun us into living in the present moment–a miraculous gift. With the onset of an illness or injury, a series of love stories begin in earnest around every child as we all seem to fall in love again.

It may be innate, I think it’s impossible to stop these love stories from unfolding when a child is ill.

A physician colleague once pointed out to me that only two things bring you to the doctor: one, anxiety about an illness (or wanting to prevent one) and two, pain. With children, when either (anxiety or pain) are present, a love story erupts around them. Immediately and passionately, those who care for children and witness their lives will work tirelessly to ease pain and suffering. In it, their love unfolds.

I’ve just realized a love story is always a part of the history of present illness. Here’s why: Read full post »

Imperfect Pediatrics

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 »