tag:blogger.com,1999:blog-77476265145501589612024-03-12T20:09:34.998-07:00DR. PERIPATETICRuminating on the medical experience...drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-7747626514550158961.post-27502126828892964692011-11-19T08:04:00.001-08:002011-11-19T08:31:53.151-08:00Forget Meds Much? Carry A Spare.<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjgNypJb_QgdNNoB0gz0wl7jbAo1VCEN59r8trUPQ5HMBM3f9IoP6q1E9Wb9AV6zvW_6LzxPHQsih7mMazfU4lwnFU0QZcYz72uv1GL-pxuQC08HBhuqLjAOtyxac89nke6Lf8A00ylMF-/s1600/42063.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="229" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjgNypJb_QgdNNoB0gz0wl7jbAo1VCEN59r8trUPQ5HMBM3f9IoP6q1E9Wb9AV6zvW_6LzxPHQsih7mMazfU4lwnFU0QZcYz72uv1GL-pxuQC08HBhuqLjAOtyxac89nke6Lf8A00ylMF-/s320/42063.jpg" width="320" /></a></div>
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How many times have you forgotten your medication at home? Or forgotten to take it with you before you headed out for dinner or an outing? Or if you take your medication at home, how many times have you gotten home late, past the time you are supposed to take your meds?<br />
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For those who have to take their medication when they are not at home, forgetting to pack them seems to be a common problem.<br />
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That's why I tell patients to pack a spare. If you're on long term medication. It's best to keep two sets of your Rx in your bag/wallet just in case you happen to forget to pack your medication. This set should only be used 'in case of emergency' and you should still pack a set to use daily.<br />
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There are lots of ways to keep spare meds:<br />
<ul>
<li>pill boxes</li>
<li><a href="http://www.sz-wholesale.com/p/Pocket-Thin-Keychain-Pill-Box/POCKET-THIN-KEYCHAIN-PILL-BOX-415064.html">key chains</a></li>
<li><a href="http://www.thingiverse.com/thing:5422">altoid tins </a>(line with saran wrap or tissue)</li>
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Just remember to use your spare meds before the expiration date! This could be easily avoided by using them before moving on to a new bottle.<br />
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Salud! <br />
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<br />drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-53810169320049762892011-09-23T13:15:00.000-07:002011-09-23T13:16:32.656-07:00Affordable Healthy Eating - Tomato Okra Sautee<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh90hP-XvdDA33mrmG9eaJmbNzb8-_PeYAHEjK_u8yFDvqTcwweutR0dlanmZD8cRlLOGsxx_-GcpPhocXo85scM4W3W-ryTqtMkUQO0EbwR35084MmuWUEzX-_OrszXRu_x3s-1eMNJgPW/s1600/-1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh90hP-XvdDA33mrmG9eaJmbNzb8-_PeYAHEjK_u8yFDvqTcwweutR0dlanmZD8cRlLOGsxx_-GcpPhocXo85scM4W3W-ryTqtMkUQO0EbwR35084MmuWUEzX-_OrszXRu_x3s-1eMNJgPW/s320/-1.jpg" width="239" /></a></div>
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Since doing health education modules with community members on hypertension, I've become especially interested in feasible, actionable ways of encouraging everyone to eat healthier. The <a href="http://www.docstoc.com/docs/document-preview.aspx?doc_id=96215417">DASH-sodium</a> diet seems <a href="http://www.nature.com/ajh/journal/vaop/ncurrent/full/ajh2011152a.html">especially successful</a> in helping people of African descent improve their blood pressure by encouraging increased fruit and vegetable consumption and decreasing salt.<br />
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Though I know healthy eating guidelines and recipes are available all over the internet, not many cater the the community with which I presently work -- low-income, African-American/Caribbean-American individuals. I hope to present some healthier/affordable options to the meals commonly eaten in this community which can be enjoyed by all!<br />
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Today's meal: Tomato Okra Sautee<br />
<ul>
<li>2lbs okra diagonally sliced</li>
<li>1 tomato diced</li>
<li>1/8 of an onion</li>
<li>pinch of sea salt</li>
<li>pepper</li>
<li>1tbsp olive OR canola oil</li>
<li>italian seasoning (or dried oregano) </li>
</ul>
To skillet on medium heat, add olive oil, let it heat for 1-2 mins, add onions and tomoto. Sautee for about 3 mins. Add okra. Add pinch of salt, black pepper, dried seasoning. Stir. Remove from heat 2 mins later (or longer if you prefer softer okra).<br />
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This is done in less than 10 mins! and can be served with brown rice.<br />
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I usually just eat it by itself, because it's sooo good!<br />
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This dish is about 3 of the recommended 4-5 servings of vegetables required daily. <br />
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Bon Appetit!<br />
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<br />drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com2tag:blogger.com,1999:blog-7747626514550158961.post-87269106690777415032011-09-15T04:09:00.000-07:002011-10-27T08:31:17.579-07:00Healthy Eating Plate<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigFMFAgypVgmzHONOPC5-x9qZa7LbS6njn0X0x2idiJGWx45KWJbPzSxGYGDX0A0xJbRF6_Dic1I9-isqV_p9x-Xkvomxx4TCZmsJ31fiIg2HEKZ7jo0gmg-FXt-6tdP6Phod6E4Xc982f/s1600/Picture+2.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="257" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEigFMFAgypVgmzHONOPC5-x9qZa7LbS6njn0X0x2idiJGWx45KWJbPzSxGYGDX0A0xJbRF6_Dic1I9-isqV_p9x-Xkvomxx4TCZmsJ31fiIg2HEKZ7jo0gmg-FXt-6tdP6Phod6E4Xc982f/s320/Picture+2.png" width="320" /></a></td></tr>
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I'm swooning over Harvard School of Public Health's <a href="http://www.health.harvard.edu/blog/harvard-to-usda-check-out-the-healthy-eating-plate-201109143344">direct challenge</a> to USDA's <a href="http://www.choosemyplate.gov/">MyPlate</a>. I love...<br />
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<li>that it is annotated -- I mean, shouldn't that be obvious, USDA?</li>
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<li>that it stresses WHOLE grains and HEALTHY proteins.</li>
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<li>that the glass is filled with water and not dairy</li>
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<li>That it notes foods to avoid and limit</li>
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<li>That it includes staying active!</li>
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Great job HSPH! I think I'll be adopting this for my health education spiels instead. </div>
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<span class="Apple-style-span" style="font-size: xx-small;">Photo credit: Harvard Health Publications. http://www.health.harvard.edu/blog/harvard-to-usda-check-out-the-healthy-eating-plate-201109143344</span>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-15210296418795056472011-09-01T09:10:00.000-07:002011-09-02T07:30:19.464-07:00Twitter-thumb : Social media-induced DeQuervain's Syndrome<div style="font-family: inherit;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw0pAXII8i95iNC1OHnaVa29q0Q-Dsd-k6000BD1foKz7V7D_2F2wTuoIH_cyffwiRvM4K5w-WUZ3_usT0Rw11fXVOcgHwP9vm5LqygSnUS6148Ron-1o8DSLlQLD27Sfi3qiLVzGJ6aA4/s1600/images.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiw0pAXII8i95iNC1OHnaVa29q0Q-Dsd-k6000BD1foKz7V7D_2F2wTuoIH_cyffwiRvM4K5w-WUZ3_usT0Rw11fXVOcgHwP9vm5LqygSnUS6148Ron-1o8DSLlQLD27Sfi3qiLVzGJ6aA4/s1600/images.jpg" /></a></div>
<span style="font-size: small;"><i>A</i>s I type, my <a href="http://www.rad.washington.edu/academics/academic-sections/msk/muscle-atlas/upper-body/extensor-pollicis-brevis">extensor pollicis brevis</a> tendon is screaming for mercy. I am forced to take several (unwanted) breaks to ease the uncomfortable mix of pain and weakness that is sometimes accompanied by the uncanny twitching of my thumb and fingers. I am suffering from a terrible case of twitter-thumb. <b>Bilateral</b> twitter-thumb.</span><br />
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<span style="font-size: small;"><b>Twitter-thumb</b> <i><br /></i></span></div>
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<li><span style="font-size: small;"><i>the horrible pain and weakness of the hand and forearm experienced by smartphone <a href="http://www.urbandictionary.com/define.php?term=twitterphile">twitterphiles</a></i></span><span style="font-size: small;"><i><br /></i></span></li>
<li><span style="font-size: small;"><i>Also known as Social Media Induced DeQuervain's Syndrome (SMIDS)</i></span><span style="font-size: small;"> </span></li>
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<span style="font-size: small;">This case of b/l twitter thumb has occurred as a result of incessant iPhone finger-swiping and thumb-tweeting by an unaplogetic social-media-phile who can barely go 10 minutes without checking something on her phone (<i>Let's see...Epocrates, Medscape, PubMed on Tap, Twitter, Blogger, Google Reader, Google+, Twitter, HuffingtonPost</i><i>, Twitter, Email, Evernote, Twitter</i>...) </span><br />
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<span style="font-size: small;">Once symptoms became unbearable on one arm, this resourceful twitterite took to ambidexterity to conquer her handicap. Now, she finds herself dually debilitated with concurrent carpal tunnel syndrome and <a href="http://emedicine.medscape.com/article/1231663-overview#a0103">cubital tunnel syndrome</a> induced by evenings spent huddled over her laptop catching-up on articles that were too long to read on her smartphone.</span><br />
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So severe is this case, that said twitterphile is now the victim of a husband-induced social media coup d'etat. iPhone and MacBookPro will soon be confiscated and mandatory immobilization has been enforced. <br />
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<span style="font-size: small;">So consider yourselves warned. Don't end up like this blogger. Protect yourself from the pain, the unbearable pain of having to do without social media for a few days. Take preventive measures:</span><br />
<ul>
<li><span style="font-size: small;"> <a href="http://mactoids.com/tap-instead-of-swipe-on-iphone-home-screen/">tap instead of swipe</a> when you can</span></li>
<li>rest regularly</li>
<li>practice <a href="http://ergonomics.about.com/od/glossary/g/defnaturalwrist.htm">ergonomically sound</a> posture</li>
<li>And take a lesson from <a href="http://www.etsy.com/listing/73756220/hand-lettered-envelope-calligraphy?ref=v1_other_2">calligraphers</a>, use the <a href="http://www.paperpenalia.com/handwriting.html">shoulder and arm</a> when you swipe -- to ease the fingers as much as you can<br /><span style="font-size: small;"></span></li>
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drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com2tag:blogger.com,1999:blog-7747626514550158961.post-87200064275600063512011-08-23T12:58:00.000-07:002011-08-31T23:37:08.040-07:00The Hidden Power of Health Fairs<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNZ6srnDpZ7k_2EOqju7WZgsqaVjJXUjIX3zffM7UOiXbpFviDnCVmbp3dqlG46JHYjsJyV6F0M-qr6wO_cl9CvtiPCBMnYNPZ0qs2kGO-fxnDChUsWMT9uvFS_YegeqLulj4VHuzm3lNo/s1600/DSC05158.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img align="left" border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiNZ6srnDpZ7k_2EOqju7WZgsqaVjJXUjIX3zffM7UOiXbpFviDnCVmbp3dqlG46JHYjsJyV6F0M-qr6wO_cl9CvtiPCBMnYNPZ0qs2kGO-fxnDChUsWMT9uvFS_YegeqLulj4VHuzm3lNo/s320/DSC05158.jpg" width="320" /></a></div>
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There is nothing like a good community health fair (HF). Away from the formal, detached sterility of the office this is an opportunity to meet patients on their turf. No longer adorned with white coat, power outfit and accompanying entourage, physician meets patient as just another member of the community, an equal almost. With a backdrop of blaring music, sweltering heat and flavorful eats people young and old gather, eager to commune in the name of health. Meeting in this context fosters rapprochement between patient and doctor. The once hierarchical encounter is no more. In this habitat, doctor and patient are in fellowship.</div>
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I enjoy health fairs because they provide the perfect merger of public health and medicine. At one instant I am advising a patient on her individual health needs; in another instant I am addressing a group on health topic salient to the community. At health fairs doctors, nurses, community organizers, nutritionists, peer educators, farmers, pastors, teachers work in tandem for the community's improved health. At these events I see my work as integrally woven into the fabric of the community's identity and goals and there are few things more powerful than the feeling of contributing to a much larger whole.<br />
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A few things I've learned from my years doing community health fairs:</div>
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<li><b><span style="font-size: large;">HFs are an excellent way to engage underserved communities in caring for their health:</span></b> Know the demographic of the community you will be serving and address topics specific to the intended community. Presentations can take the form of small workshops targetting subgroups of the community (e.g. childhood asthma, osteoporosis in adult women) or they may be short PSA type announcements to all attendees (e.g. top three diseases affecting the community). Either method would increase awareness and spark conversation that could foster deeper contemplation and even lifestyle change long after the health fair.</li>
<li><span style="font-size: large;"><b>HFs offer a unique opportunity to engage patients in the community with which they self-identify</b>:</span> When general health concerns are addressed in a group setting, individuals may be comforted by knowing others in the group share the same concerns that they do. It also works when trying to get a message across -- and may very well push those in <a href="http://www.aafp.org/afp/20000301/1409.html">precontemplation</a> stage squarely into action. A sort of herd mentality (think Malcom Gladwell's <i>The Tipping Point</i>), if you will. This can be an effective tool for us physicians in successful health promotion.</li>
<li><span style="font-size: large;"><b>HFs are a great opportunity to field patient questions</b>:</span> People have many burning questions about health related topics in the media that they may not get to ask their physician. HFs provide a great forum where those questions can be answered. For example, at my last health fair the community was mainly christian Caribbean-Americans. With <a href="http://well.blogs.nytimes.com/2011/08/18/bill-clintons-vegan-journey/">Bill Clinton's veganism</a> making the news, I was cheerily accosted by a group of men who were curious about the topic. I was all too excited to engage these Caribbean men -- avid meat lovers, notoriously averse to a herbivorous diet. To find myself suddenly engaged in this 'health huddle' and fortifying their interest in eating more fruit & vegetables was truly a delight and certainly not something that one could recreate in the office.</li>
<li><span style="font-size: large;"><b>HFs uncover and provide the platform to correct misconceptions</b>:</span> Patients don't always talk freely in the office, even if you're the crown master of open-ended questioning. The relaxed and collegial nature of the HF allowed for more time to speak openly with patients. I was privy to their opinions on taking medications, their reasoning behind not seeing a physician about a year long wheeze and learned alot about their work and home life. These conversations uncovered several misconceptions -- some were individuality held others reflected the general disposition of the community. Many had to be addressed! This led to impromptu sessions to correct these misconceptions and set the record straight for the sake of the community's health.</li>
<li><span style="font-size: large;"><b>HFs can grow your practice</b></span> - I<span style="font-size: small;"> don't have my own practice (yet)</span> but I got several inquiries about coming to "my office". Had I been out of residency and practicing, I could have had several additions to my practice from that one HF. One physician's practice <a href="http://www.aafp.org/online/en/home/publications/news/news-now/health-of-the-public/20061205weidahealthfair.html">grew astronomically</a> after hosting several health fairs. </li>
<li><b><span style="font-size: large;">HFs are fun!</span> </b>Dr Jan Gurley (<a href="http://twitter.com/#%21/DocGurley">@docgurley</a>) is <a href="http://schweitzerfellowship.wordpress.com/2011/08/18/%E2%80%9Cthe-addictive-power-of-spending-ones-days-doing-something-worthwhile%E2%80%9D-five-questions-for-a-fellow-with-jan-gurley-md/">right</a> -- there is indeed "addictive power [about] spending one's day doing something worthwhile." HFs truly are a lesson in servant leadership and are a very fulfilling experience. Volunteer at a health fair one day. You won't regret it!</li>
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<br />drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-81187674737943092042011-08-05T12:24:00.000-07:002011-08-29T10:37:02.531-07:00The (FM) Revolution Will be Tweeted!<div class="separator" style="clear: both; text-align: center;">
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If you're in medicine and on twitter and haven't come across the #FMRevolution hashtag, you must be, like the Geico commercial says, living under a rock. Since March 2011, Family Medicine has been taking the twitterverse by storm.<span class="Apple-style-span" style="color: red;"> </span>What first started as the "Family Medicine T-shirt Revolution" at a California Family Medicine summit in 2010 has now turned into a fulfledged <a href="http://www.familymedicinerevolution.org/">campaign</a> to debunk misconceptions about the specialty, dispel misgivings about pursuing the field and to advocate for primary care as a cost-effective specialty with proven results in improving health outcomes . The revolution has been rallying physicians, residents and students nationwide to the cause.</div>
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Leading the battalion of revolutionaries are <a href="http://twitter.com/#%21/drmikesevilla">@drmikesevilla</a>, <a href="http://twitter.com/#%21/familydocwonk">@familydocwonk</a>, <a href="http://twitter.com/#%21/BernieMD31">@berniemd31</a> <a href="http://twitter.com/#%21/RichmondDoc">@richmondDoc</a>. These docs and many others tweet daily on their private practice experiences, medical education, the use of new technologies/social media in their practice. They tweet from conferences, from their lunch breaks and even while boarding flights to speaking engagements. They keep us informed with the latest news in the field.<br />
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Their presence on twitter has made #FMRevolution a top trending topic for those of us in health and social media and has made it one of the most (if not THE most) visible specialties in social media to date. In the twittersphere, family medicine is not the dreaded 6-week mandatory rotation the MS4 is glad to be over with nor is it the often jeered at, unglamorous lower rung cousin of more "prestigious" specialties. No, on Twitter, Family Medicine is a vibrant community of leaders and innovators, great teachers and mentors setting the pace for the future of medicine.<br />
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I applaud the physicians who have taken the helm with the #FMRevolution as they make strides for family medicine and set great examples for us young primary care physicians.<br />
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<i>Click </i><a href="http://www.familymedicinerevolution.org/who-we-are/what-is-fmrevolution/"><i>here</i></a><i> for more on origins and be a part of FMRevolution!</i>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-46101621549855964062011-07-29T09:18:00.000-07:002011-08-31T23:37:49.425-07:00...and mentorship<div style="background-color: transparent; font-family: inherit;">
<span id="internal-source-marker_0.7763900163117796" style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">Harvard MSIV, Nate Favini, did an </span></span><a href="http://natefavini.com/post/8180069977/medical-student-indebtedness-and-career-decisions"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">excellent commentary</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> on Dr. Pauline Chen’s NY Times article entitiled, “</span></span><a href="http://well.blogs.nytimes.com/2011/07/28/the-hidden-costs-of-medical-student-debt/"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">The Hidden Cost of Medical Student Debt</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">”. Mr. Favini aptly added lack of economic diversity and personal motivation as key elements that affect medstudents’ desire to pursue primary care, in addition to debt. Both articles made strong cases and I suggest we add another to the list of factors contributing to med student interest in primary care -- mentorship.</span></span><span class="Apple-style-span" style="color: #666666;"></span><br />
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<span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">I, like the </span></span><a href="http://ajph.aphapublications.org/cgi/content/abstract/100/11/2168"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">AJPH article</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> Mr. Favini cited, have long had a deep commitment to the “overworked and underserved” choosing to lead countless health fairs and educate prisoners about HIV/AIDS and sexual health while in medical school. I am also one of the 10 percent of medical students cited in Dr. Chen’s article, who come from incomes in the lowest 40th percentile. I see myself reflected in my patients and my desire to help them is almost a natural corollary to that fact. In addition, I have no qualms with living comfortably on a primary care physician’s salary, debt and all. Throughout medical school however, whenever I mentioned my interest in primary care, I received well-known looks of disdain/confusion and was repeatedly advised to choose a “more interesting specialty” where I would “actually get to practice medicine.” Despite this, I still managed to pursue a career in primary care but it was often a difficult decision to make. I was hard-pressed to find mentors. </span></span><span class="Apple-style-span" style="color: #666666;"><br />
<span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">A mentor helps to nurture interest. This Journal of General Internal Medicine </span></span><a href="http://www.springerlink.com/content/j8v870051w76hq88/"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">article</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> cites </span></span><a href="http://www.amazon.com/Seasons-Mans-Life-Daniel-Levinson/dp/0345339010/ref=sr_1_1?ie=UTF8&qid=1311952630&sr=8-1"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">Daniel Levinson's</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> perceived responsibilities of the mentorship relationship as:</span></span><br />
<ul>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">teaching </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">sponsoring </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">guidance </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">socialization to profession </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">counsel </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">moral support </span></span></li>
<li style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">realization of the dream</span></span></li>
</ul>
<span class="Apple-style-span" style="color: #666666;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">Attendings often master teaching and even socialization to the profession but it is often quite difficult for a medical student to find a role model who takes vested interest in guiding, counselling and providing support needed to realize THE dream. Primary care physicians may be too busy and too much in need of compensation to mentor. An article from </span></span><a href="http://news.brown.edu/pressreleases/2011/03/primary"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">Brown University</span></span></a><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> states,</span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;"> </span></span><span class="Apple-style-span" style="color: #666666;"><br />
<span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><br />
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<span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">“</span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: bold; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">In the current health care system, primary care doctors are constantly under pressure to see as many patients as possible. Time spent as a preceptor, instead of with a patient, is lost revenue.</span></span><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span" style="color: #666666;">”</span></span></div>
<span class="Apple-style-span" style="color: #666666;"><span style="background-color: transparent; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></span><br />
<span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I propose that while a physician may see mentoring as </span><span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: italic; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">personal </span><span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">revenue lost, s/he may not realize the significant gains it would have for primary care as a specialty. Time spent nurturing medical students’ interest in primary care can lead to increases in the number of students who pursue it in residency. Deep motivation (this time by physicians) to advance the field is needed. Through a grant, Brown University has found some </span><a href="http://www.rifoundation.org/News/NewsArticles/tabid/513/ArticleId/113/Foundation-Alpert-Medical-School-Lifespan-launch-new-initiative.aspx"><span style="background-color: transparent; color: #000099; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">motivation</span></a><span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> for its physicians and is now actively promoting primary care choices in its medical students. Perhaps other medical schools can do the same. Even, developing CME courses to teach the tenets of mentorship. </span><br />
<span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span><br />
<span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The government is making an effort to increase the number of primary care spots in residency through its </span><a href="http://www.grants.gov/search/search.do?mode=VIEW&oppId=55287"><span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Primary Care Residency Expansion Program</span></a><span style="background-color: transparent; color: black; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. I</span><span style="background-color: transparent; color: #666666; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">n order to fill these spots with residents who are truly dedicated to primary care, the encouragement must begin in medical school. For students who are like I was, mentorship may provide the extra push needed to pursue this fulfilling and rewarding career.</span></div>
drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-66020348634802566402011-07-26T00:43:00.000-07:002011-08-22T23:30:16.967-07:00Memories<div class="separator" style="clear: both; text-align: center;"></div>I recently rediscovered some of my clinical rotation musings. Enjoy...<br />
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</div><div style="text-align: center;">Since my last writing I've moved from no longer wanting to be a surgeon to falling in love with pediatrics. I often wonder to what extent students' specialty decisions are influenced by their rotation experience. My pediatric experience was phenomenal. The most organized rotation I have seen yet. But more than the syllabus and organization of the rotation, were the people. For the first time, I saw myself in these attendings and residents. I saw qualities that are dear to me being reflected in these individuals -- advocacy, service, compassion. I saw an environment where residents and attendings shared mutual respect, not chilling fear or measured disdain. The atmosphere was one where I was always excited to be there, where I welcomed the challenge. Had I done my rotation elsewhere, would I have felt the same way about pediatrics?<br />
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To write is to bare all. To opt to put things only known to you out in the open for the world to experience and criticize. To do such takes bravery. Bravery I may be lacking. The journey in medicine should involve sincere introspection as one decides on specialty, writes personal statements and interacts with varied patients. It should involve growth. I sometimes feel like the self I know is slowly drifting away. Is this what growth is?<br />
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<div class="separator" style="clear: both; text-align: center;"></div>Fell sick for the first time in the OR today. Put my mask on too tight? All of a sudden I was diaphoretic, the mask gnawing at my carotids and smothering each breath. The plastic shield, now glued to my forehead by droplets of sweat, was no longer transparent. Condensation rendered me blind.<br />
For the first time, the smell of burning flesh made me nauseous.</div>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com1tag:blogger.com,1999:blog-7747626514550158961.post-33639515412404353172011-07-22T09:22:00.000-07:002011-08-31T23:38:25.736-07:00Do As I Say, Not As I Do<div style="background-color: transparent; font-family: inherit;">
<div style="text-align: justify;">
<span id="internal-source-marker_0.2901577565353364" style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">I’ve heard patients say, “How could she smoke and she’s a doctor?” Alarmed and bewildered by the fact that an agent of health could partake in one of the most harmful acts of bodily destruction. In medical school, a sizable number of my classmates smoked and I always found it so counter-intuitive, mind-boggling that they would be learning about smoker’s lung in pathology and on class breaks would huddled outside the lecture hall sucking on their cancer sticks. These same colleagues would then be encouraged to exhort smoking cessation in our clinical skills session while we all sit, simulated patient included, in a room rife with the heaviness of second hand smoke. One would assume that there should be a direct correlation between knowledge on a topic and healthy decision-making but we know all too well that that is not the case. As </span></span></span><span style="font-size: small;"><a href="http://thedecisiontree.com/blog/thomas-goetz/"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">Thomas Goetz</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> states, fear of illness is </span></span></span><span style="font-size: small;"><a href="http://www.wired.com/magazine/2011/06/ff_feedbackloop/all/1"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">not sustainable motivator for positive change</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> in health behavior and that is true even if you’re a physician. It has certainly been true of me.</span></span></span><br />
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<span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">For the first time in my life, I am approaching overweight. I have a BMI of 24.5. I feel awful, guilty and of course, hypocritical when I encourage patients to eat healthy and exercise, knowing that after work, I’m headed straight to Micky D’s for a snack wrap and fries on the way home, to then sit on the computer for hours instead of going running or doing my P90X work out that I planned.</span></span></span></div>
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<span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">I had been a vegetarian for 7 years, an exemplar for great health, a dancer, hiker, frequenting pilates and yoga classes - ever mindful of what I put in my body, knowing that eating healthy now would save me the medical bills later in life. Now, I pick at my mother-in-law’s stewed pork, munch on way too many cookies, and would eat all the mac and cheese in the world if I could. I barely eat portion one of the five portions of fruit and veggies we should all consume each day and please don’t ask me when was the last time I went to the gym. One would assume that as I watch the dial on the scale climb, see buttons of my favorite dresses pop out and feel my jeans rip at the thigh each time I wiggle into them that I would spring into action but this was more easily envisioned than practiced. The guilt increased as I increased in size, the will the make change was there but for some reason it could not be translated into action. While studying for my public health degree we learned of the </span></span></span><span style="font-size: small;"><a href="http://www.flickr.com/photos/bosquetango/1167655/"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">stages of change</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> for behavioral health. I see myself lingering somewhere between contemplation and preparation, never quite making it to action. How then could I encourage my patients to action?</span></span></span></div>
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<span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">I remember when surgeon-general Regina Benjamin was nominated for the position and her </span></span></span><span style="font-size: small;"><a href="http://well.blogs.nytimes.com/2010/01/11/the-surgeon-generals-weight-struggle/"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">weight</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> was an issue. If she was to lead the country in overcoming obesity, shouldn’t she be setting the example? Conversely, a recent American Medical News </span></span></span><span style="font-size: small;"><a href="http://www.ama-assn.org/amednews/2011/07/18/prsa0718.htm"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">article</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> highlighted that doctors who share the same illnesses as their patients are usually better able to connect with patients as a result -- a doctor with multiple sclerosis has a leg up on other neurologists because he has felt the numbness in the legs that the patient is reporting. Instead of feeling guilty, could I not see my own struggle as a way of finally getting into the psyche of my overweight patients with diabetes and hypertension? Like them, I was too busy to prepare my own food and found fast food to be the more convenient, I had limited funds and again fast food, being a cheap option, was the easy option. With 3 fast food chains all within five blocks of my house it was just easier to walk there than to make the 1 mile trek to the nearest green grocer. So I began to tell my patients of my own struggle. </span></span></span></div>
<div style="text-align: justify;">
<span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">We would joke about eating burgers and fries but then I would let them know of the salad and fruit options available at those same restaurants. I would tell them how I turned my one mile trek to the green grocer into my daily exercise. How I cut up all my veggies and froze them to save time in preparation for later. For my patients with iPhone’s I would rave about the </span></span></span><span style="font-size: small;"><a href="http://www.loseit.com/"><span style="background-color: transparent; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;">Lose It! app</span></span></span></a></span><span style="background-color: transparent; font-size: small; font-style: normal; font-variant: normal; font-weight: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-style-span"><span class="Apple-style-span" style="color: #444444;"> which has helped me keep track of my progress. The more I shared my experiences and lessons learned with my patients, the more receptive and appreciative they seemed. I seemed human to them, not just another paternalistic know-it-all admonishing them and requesting unrealistic change. I learned that as doctors, while it is imperative that we practice what we preach, we at times, do fail. These failures can be an opportunity to reach out to patients, to identify with their own struggles and work together with them to improve health. I am now dancing twice a week and try to make it to the gym as often as I can. I always carry fruit in my bag and bypass all fast-food restaurants on the way home.</span></span></span></div>
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drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-65456371787981558292011-06-22T12:04:00.000-07:002011-08-31T23:39:03.113-07:00Yes! Take notes at the doctor's office.<div style="font-family: inherit;">
As a recently minted physician, I am often on the receiving end of the gripes and grouses about the medical profession. Often I get complaints of office visits that are too short, doctors who seem too preoccupied to hear their patients' complaints, medical bills that are too high and medications that do nothing but cause adverse effects. On the other hand, I can't count the number of times I have left the exam room, convinced I have gotten the most complete and accurate information from the patient only to be confronted by the attending on something I had 'missed'. <i>Really?!?!? I just asked her that and she denied having chest pain one week ago! </i>The truth is, patients are often intimidated and confused by the whole medical experience and in this state are even more likely to forget the details of their medical history, thus creating a less than ideal environment for optimizing health. Something needs to be done to improve the doctor's visit, both for patients and for physicians.</div>
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Posts from by the <a href="http://www.humanism-in-medicine.org/index.php/you_your_doctor/gold_guidelines_for_doctor_visits">Gold Foundation</a> and by Dr. Melanie Lane on <a href="http://www.kevinmd.com/blog/2011/06/time-spent-doctor-minimize-patient-frustration.html#comments">KevinMD </a>today reminded me that this is a topic I've wanted to write about for some time. These articles provide solid advice for having a successful visit. I'll add my $0.02 and say that one easy solution to many misunderstandings and misinterpretations at a doctor's visit is to have a L<i>ittle Black Book of Health</i>. In these times it seems so natural to document our every thought and action why not do the same for our health?</div>
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Your LBBH can be either a written or digital record of your health journey and is especially handy for those with multiple illnesses. Just as making notes during lecture solidifies learning, so too can this habit of taking notes facilitate understanding your goals of care and provide a timeline of your health progression. Here's how to use your LBBH:</div>
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<li><b>Document your symptoms</b> - What are the symptoms? When did they begin? What were you doing when these symptoms began? Have the symptoms improved or worsened since the beginning? What medications have you taken to relieve the symptoms? Have you used any alternative therapies also? These are questions your doctor will ask you so you might as well be thinking about them before you arrive , writing them down will save you from forgetting important details.</li>
<li><b>Document your doctor's name and specialt</b>y - This is especially true if you have multiple doctors. Most patients know their PCP but often times when I ask about the specialist s/he went to see the patient either does not know what that specialty is or s/he does not remember the name of the doctor. Knowing these details saves some time sleuthing around on Google trying to match names of doctors phonetically. It also makes for easy communication with that specialist if need be. </li>
<li><b>Take notes at your visit </b>- If you don't understand something, ask your doctor to repeat it to you. Know the name of your condition, know what the doctor recommends that you do. Ask her to spell the names of medications she is prescribing. Take note of each medication prescribed, the dosage and at what time of day it should be taken, with meals or without. I can't tell of the number of times patients mix-up medications and dosages just because they didn't fully understand what their physician directed them to do at the last visit.</li>
<li><b>Keep a medication lis</b>t - As mentioned before, you want to record the names and dosages of your medications. Equally important is recording when you began taking a particular medication, when your doctor discontinued the medication or changed the dosage or the drug altogether. Note side-effects also.This can help both you and your doctor by reducing polypharmacy and medication list comes in handy if you ever, God forbid, end up in an emergency room. </li>
<li><b>Keep your LBBH with you! </b>- In your pocket, your handbag, and take it on every doctor's visit/hospital stay it will make your (medical) life so much easier!</li>
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The idea of the LBBH is not unique, think to pediatrics. Parents know to walk with the little yellow card that documents the timeline of a child's immunizations. The LBBH can do the same for adults with more complex comorbidities.</div>
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drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-3581315085142026082010-11-25T22:37:00.000-08:002010-11-25T22:37:07.399-08:00Blackened Tilapia dinner<iframe width="480" height="295" src="http://www.youtube.com/embed/hUkF5Uqf3Xs?fs=1" frameborder="0"></iframe>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-20859409325976662062010-11-08T18:47:00.000-08:002010-11-08T20:01:24.352-08:00Gotta Love The Babies<b>Me</b>: Okay Jonathon, the virus caused you to vomit a lot and now you're dehydrated. We need to <span class="Apple-tab-span" style="white-space:pre"> </span>get your fluids back up to par, so we'll have to place you on an IV drip. You'll be brave and <span class="Apple-tab-span" style="white-space:pre"> </span>allow me to do it right?<div><br /><div><b>10 year old:</b> (bawling, tears running down face)Nooo!It's gonna hurt! Mommy, she's gonna stick <span class="Apple-tab-span" style="white-space:pre"> </span>me!</div><div><br /></div><div>(After 5 mins of successfully consoling him)</div><div><b>Me:</b> OK, you're brave, you're strong, it's just a little stick, then the pain goes away. </div><div>10 year old (no longer crying): OK, I'm ready</div><div><br /></div><div>(First attempt: he flinches. Unsuccessful)</div><div>(Second attempt: he flinches again. Unsuccessful)</div><div><br /></div><div>(On third attempt...)</div><div> <b>10 year old:</b> Are you new here? How come you can't get it in yet?</div><div><br /></div><div>-----------------------------------------------</div><div><i>Seeing Jamaican patient and 4 year old son at Ob-Gyn clinic.</i></div><div><i><br /></i></div><div><b>Me:</b> Okay mom, we're going to have to draw some blood to check your blood sugar level.</div><div><b>Patient:</b> Okay Doc</div><div><br /></div><div>(I get supplies, begin advancing venipuncture needle)</div><div><br /></div><div><b>Patient's son</b>: No! Don't juk mih mommy!</div><div><br /></div><div><br /></div></div>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-89670350854996137762010-11-03T10:07:00.000-07:002010-11-08T20:01:24.369-08:00Back in (somewhat) full force.I started this because I wanted to write. I wanted to express myself. But like many other things. Procrastination/life got the better of me and I neglected to follow through on my promise to myself. So here I am again, attempting to get it started, trying my best to make the best of it. I've taken a month of to regroup, recuperate from the madness of the past several months. I am praying for a future of success and future of organization, peace, of financial prowess. Each day is indeed a blessing I give thanks for where I've come.drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-48858593891362435292010-04-08T23:01:00.000-07:002011-08-19T09:41:55.198-07:00From object to subjectIt is important to care. To stop, get out of one's own self-involved space and listen, look, experience the world as the patient does. Today some of our residents were berated for just that. For treating patients as routine. For filling out the checklists, doing the minimal required and not truly assessing the patient in her (I'm on OBGyn service) wholeness. It's something physicians get criticized for regularly, but it really takes going against the grain to do such. The way we report cases and approach an individual is indeed depersonalized and sterile. "Patient is 34 year old female complaining of .... G1P0, previous C-section...." I wish I could convey the tone in which it is presented too. Often times it seems that patient is object, rather than subject of the medical conversation. It has been some months since I've been in clinical rotations and I still find it hard to present. Perhaps it's because I have not mastered organizing the systematic process in my head but the fact that I find it hard to separate my inclination to have a connection with the patient from the depersonalized nature of presenting may also be a contributing factor.<br />
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Certainly such methods are necessary to highlight the most salient aspects relating to the patient and to prioritize steps for care but to do such and be a provider with whom patients can connect, to me, means existing in two states at once. Without practice, these states can seem mutually exclusive.<br />
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A friend of mine, very young person, has cancer and she opted to create an online journal of the treatment course. In it she shared her fear, confusion of navigating insurance and doctor networks, her need to advocate for herself, because sometimes, her doctor wouldn't. As physicians-in-training, our role is not to only treat the illness but to convert that fear into trust, the confusion into understanding and turn the object into subject of our care.<br />
May this one day be innate in all of us.drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-70584842205446346712009-12-31T19:14:00.000-08:002011-08-19T19:16:41.611-07:00Contact MeTwitter: <a href="http://www.twitter.com/drperipatetic">@drperipatetic</a>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.comtag:blogger.com,1999:blog-7747626514550158961.post-44164716422958823242009-12-31T19:11:00.000-08:002011-08-19T19:13:08.929-07:00DisclaimerAlways get medical advice from *your* doctor. Thoughts expressed here are all my own and should not serve as a substitute for visiting your physician. drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.comtag:blogger.com,1999:blog-7747626514550158961.post-45188669929553342262009-12-31T19:05:00.000-08:002011-08-19T19:11:37.267-07:00About MeMD::MPH::Artist::Activist intrigued by stories of the medical experience, healthcare politics, meded, global health and art. Excited by social media's power to teach, engage and change. I ruminate on these topics in this blog.drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.comtag:blogger.com,1999:blog-7747626514550158961.post-26700213433264466362009-12-13T10:14:00.000-08:002010-11-08T20:01:24.467-08:00SurgeryToday surgery began. The transition is bitter more than sweet. I remember dreaming of being a neurosurgeon when I was a child, writing about it in my personal statement for college. But now, it seems so far away. Medicine is a place where you find yourself. You spend a significant amount of time interacting with varying personalities, adjusting to new teams of people, new environments. You can never get too settled or too comfortable and so you're always forced to question, who you are, what you're about and to prove your worth, if not to anyone else, to yourself. And I find myself today, wishing I was still in internal medicine, wishing I had done more, taken more from the experience and dreading the famed personalities of the surgical house staff. Of course, waking up early is also not something I'm excited about, but that aside, I fear my laid back nature will be ruffled in the coming 12 weeks and I pray my soul can bear the struggle. I find myself, out of character and instead of being my usual optimistic self, I dread the coming weeks. I pray for blessings, peace and guidance in all my forthcoming doings.drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-67089662000847112582009-12-13T10:01:00.000-08:002010-11-08T20:01:24.486-08:00The beginning<span style="font-family: arial;font-size:85%;" >12 weeks have gone by and I should have been writing an article a day but that didn’t happen. What’s new? Time flies when you're having fun, they say, or time flies when you're tired, disorganized and scared. I'm pretty preoccupied with the future -- with deciding how what specialty fits into my life plan (or fits my emotional and egotistical desires that day) and when I should take step 2, step 3, which residencies to apply to, worrying about my visa status. Instead of just studying now. I have to admit, I enjoy planning my not so distant future and obsessing over it, but I also need to save some of that energy up for the situation that's right before me - rotations. It's week 11 of 12 for IM, my first rotation as an MSIII and fortunately, I'm not burnt out yet. I'm tired, but not burnt out (I think). I still enjoy meeting patients, hearing their stories, figuring out their problems and navigating the galaxy of differentials, diagnostics and treatments. But I'm really good at finding the joy in things and that sometimes can be a curse. It makes decision-making difficult because I'm unable to find subjective reasons that would help me rule out or rule in certain factors. I can only hope, that in the next year, I can be truly honest with myself, truly understand myself to know what I would be most fulfilled with in the future. </span>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0tag:blogger.com,1999:blog-7747626514550158961.post-1370670313861538592009-12-13T09:55:00.000-08:002010-11-08T20:01:24.508-08:00Expired<span style="font-family: arial;">This week my patient died. She was 76 years old. Chinese lady. Brought in because of a UTI and found to be in respiratory distress. I met her, tubes down her throat, respirator injecting air into her lungs every 3 seconds, unconscious. Unaware of her present state - her inability to breathe on her own, her incontinence and the massive swelling all over her tiny body. She was oozing fluid as she was most likely protein deficient and had developed edema as a result. The fact that she was on normal saline did nothing to ease this either. She died at night. I wasn't there, but I can't help but wonder the cause of her death. Could it have been pulmonary edema? She was edematous in all other places, why not the lungs too? Coming to work the next day and hearing that she had expired left me somewhat dejected for the rest of the day. Of the four days she had been in the hospital, no family members had ever come to visit. She died alone, cold, swollen on a hospital bed. Who knew the fulfilling life she once lived?! I said a prayer. That in passing on, she be blessed. </span><br /><br /><span style="font-family: arial;">In contrast, the next day, another patient passed. This Chinese lady was surrounded by family even before her passing. They took shifts so she was always in the company of a dear family member throughout the day. When we rounded, her granddaughter was there. She could not be more than 22 years old. She flew in from Europe to be at her ailing grandmother's bedside. The day she died, There were at least 15 people in that room, solemn and red-eyed. They had expected it and had made peace with what transpired. Even in this sad moment they chose to thank us, the medical staff, profusely for taking care of their grandmother, mother, sister. She died, not connected to a web of tubes and IV lines, but rather, on the last of her own natural breath.</span>drperipatetichttp://www.blogger.com/profile/08167606606889540176noreply@blogger.com0