Watchful Waiting and a Prescription for Love

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Winter.  That time of year when my office is full of children with viral infections that I can do nothing to improve.  I routinely recommend treatments as technical as rest, humidifiers, steamy showers, and water.  Yes, water.  And if I’m feeling more exotic, I suggest honey.  And almost universally, parents look back at me and say, “is that it?”  This is a season of disappointed and frustrated stares.

In her book, On Immunity, Eula Biss says, “the wise practice of waiting and watching is hard to sell, in part because it looks a lot like doing nothing.”  When doctors are pressured into doing something, when the right answer is to do nothing, harm can ensue.  Biss continues that “the purpose of heroic medicine was not so much to heal the patient as it was to produce some measurable, and ideally dramatic, effect for which the patient could be billed.”  Writing an antibiotic prescription would be much easier than a lengthy discussion about viruses versus bacteria, but doing something is not always the right decision and sometimes watchful waiting is what is best for the patient.  As a steward of antibiotics, it is also part of my job to use them wisely and appropriately for the clinical situation.

I have been the patient though with the miserable viral illness.  Wrapped in blankets, surrounded by tissues, and sipping chicken soup, I have also pleaded for “something” to make me feel better.  We all want some magic pill to take away our suffering in those moments.  When your child is sick though, this desire to find a cure is even more pronounced.  I know the heartbreak of watching your ill child, the burden of missed days of school and work, and the misery of sleepless nights.

While I may not be able to prescribe a cure for the viral illnesses that walk into my office, there is some guidance that I can offer based on my experiences with them.  When one patient inquired on my way out the door, “hey wait, where’s my medicine,” it felt good to inform him that his mommy was taking good care of him and that was all he needed.  In the end, I know he will get better and empowering his mom to trust that the warm tea, vaporizer, and back rubs she is giving him are all the medicine he needs is the best prescription I can give.

Gendered Pronouns in Healthcare

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I am far from a Women’s Studies professor, but I do consider myself a feminist and went to a women’s college, so I am fairly tuned in to gendered language and sexist thought.  Although, I surprise myself regularly with gendered pronouns in unexpected places and once I noticed this trend I thought I needed to acknowledge it (here) and then remedy it (everywhere).

During college I remember reading a lot about how gendered language influences children’s concept development and leads to socialization of gender roles.  Seemingly innocent presumptions that boys drive cars and girls play with dolls become self-fulfilling prophecies.  As I raise my own children I am conscious of the ways that we consciously and unconsciously socialize their gender roles.

The place where I had not thought much about this though was at work.  I tend to use open-ended questions with kids so I do not presume that they like dolls or trucks, but rather follow their lead.  However, I noticed that gendered language started to creep in when I was talking about colleagues within my own profession.  Parents would tell me that they saw another doctor and I would often ask, “what was his name?” only then to have them respond with her name.  It continued with other professionals, like the occupational therapist that I referred to as her (it was him) and the dentist who was her instead of him.  These gendered pronouns correspond with the genders of the professionals I have the most experience with from my childhood.  I had a male pediatrician and dentist and most of the occupational therapists I have met have been women.

Besides being biased by my own personal experiences, I wondered, how far off my gender stereotypes were from reality?  According to the American Academy of Pediatrics (AAP), 71% of pediatricians under 35 years old are female, compared to only 30% of those over 65 years old.  Coming down the pipeline, 47% of medical school graduates are women.  So while there are still slightly more male physicians, pediatricians are more likely to be female, especially now.  However, only 18-23% of Pennsylvania dentists are women.  On the other hand, 85-91% of occupational therapy students in 2011 were women.  So I learned that my gender stereotypes were supported by the statistics.  That still did not make it right though.

What message does my gendered language send to my young patients?  Should they learn that although they have a female pediatrician that I assume most other doctors are male?  Should dentists also be male?  Are people in more caring professions with lower salaries automatically women?  It bothered me every time I was caught in one of these sexist presumptions and felt the impressionable eyes of my young patients absorbing it all.

So I will continue giving out princess coloring papers to boys, Spiderman stickers to girls, and take care not to assume the gender of my colleagues when choosing my pronouns.  While all of the pediatric dentists I know in my area are men, I now make sure to ask what a child’s dentist’s name is rather than what his name is and the importance of this was reinforced when one of my recent patients informed me that she would like to be a dentist.  I remember being that little girl and telling my pediatrician that one day I would share his career.

A Different Kind of Computer Science

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As a resident, I asked my husband what he thought a typical work day was like for me and his response was a conglomeration of various TV doctor shows.  It involved a lot of walking around in large groups with white coats, reading charts that hung from the foot of patients’ beds, and gossiping in the supply closets and cafeteria.  When I told him what my day was really like, he was shocked to hear how much time I actually sat behind a computer.  After all, TV doctors aren’t spending their time typing since it would make for boring air time… but does it make for boring real life?

Electronic medical records have many virtues and in many ways have made my job easier.  Patient’s vital signs, lab tests, and medical history are just a click away.  I do not have to decipher my colleague’s handwriting anymore since it is all neatly typed and formatted.  Even as a resident, a majority of my day was spent tied to a computer, whether it was during sign out where we checked our patient lists, or rounds where we entered orders, or during our work time where we followed up tests, typed notes, and re-entered orders.  The burden of administrative work made time at the computer feel as essential as time at the bedside, and even as we participated in family-centered rounds, we dragged computers on wheels along with us.  So many of my patient encounters were spent peering around or over computer screens.

As a primary care attending this is somewhat better, however, we still spend much of our visit in front of a screen.  I strive each visit to balance the efficiency of charting while we talk with developing rapport in a naturally flowing conversation that is unconstrained by the computer templates.  I try not to let the computer come between us or my back turn to the family as I type, however, I know that these things happen and that no social interaction that is filtered through technology will feel entirely organic.  As much as I try to keep the computer inconspicuous, it feels as essential to my toolkit as my tongue depressors and stethoscope.

My patients have come to rely on our computers as well.  Parents often say things like, “you’ll see xyz in your computer” or “I can’t remember, can you check the chart.”  They like that their history is compiled, organized, and catalogued for them.  Through a few clicks, I can read about their recent Emergency Room or sub-specialist visits, send prescriptions to their preferred pharmacy, communicate with teachers, and enroll them in services like Early Intervention or research studies.  My patients can log in from home and view their own lab results or send me an email.  When it comes to technology, instead of less, they are often asking for more!

I am thankful that I grew up with computers so that typing comes with ease and that integrating the science of computers into the science of medicine feels less cumbersome and more cooperative.  When I imagined myself as a physician years ago, I never visualized a computer as an essential tool in my trade, but it certainly has become one.  I try not to let it overtake our office visit though, and the kids in my office typically facilitate this with their (age-appropriate) short patience.  When a toddler starts climbing the walls or a preschooler bores after finishing coloring, I leave the comfort of clicking through structured prompts in my history-gathering to engage children in fun open-ended questions.  Eventually though, I have to return to typing to document everything in the record.  So while I lecture my patients on limiting their screen time, I strive to find my own balance in doing so as well.

When a Colonoscopy Suite Becomes Your Spa

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At the end of my intern year, as my classmates headed off to vacation on tropical islands, I found myself taking my board exam and having a colonoscopy.  It was not quite the reward that completion of internship deserved, but I took advantage of my limited free time to schedule these necessities and having that sort of freedom was a bit of a luxury in itself.

Balancing my personal life and residency left me feeling like I dashed from one activity to another with little time to decompress.  My thirty-minute bus ride to and from the hospital was the closest I came to me-time and watching reality TV before falling asleep on my couch was my weekly mini-vacation.  So after a year of 80-hour work weeks, having a week off to do as I pleased minus one day of colonoscopy prep still felt luxurious.

Nothing about a colonoscopy is fun, but it ended up being more spa-like than I imagined.  After the short procedure, the nurses informed me that I would wake up in a recovery room and at that time my husband could take me home.  The entire thing from start-to-finish was supposed to be an hour or two at most.  Once I started to drift back into consciousness, feeling the crinkling of the stretcher’s plastic covering beneath me and the nurses chatter at their nearby station, I inquired about what time it was.  Even on vacation, I felt compelled by a drive for efficiency and my mind started to jump to what I next needed to accomplish before my body was even ready to move.  My nurse came over and with a hand on my shoulder said, “Oh sweetie, you have been sleeping for four hours.  We knew how exhausted you must be so we just let you sleep.”  Four hours!  I was so embarrassed that this open stretcher in an anesthesia recovery room surrounded by dinging monitors and doctor banter had been one of the best naps I had in a year.  I imagined the nurses walking passed me for hours, probably shaking their heads in pity at the poor resident sleeping in the colonoscopy suite.  How had I let myself get to this point?

A few years and two kids later, I sometimes still feel this way.  I have found respite in activities that others would deem unpleasant, like the dentist, or circling for a parking spot.  These chores, when done alone, force me to disconnect from work, media, and childcare responsibilities.  I cannot rush them, have no interruptions, and unlike my typical day where I take care of others, I am able to sit alone with my thoughts and reflect on what I need.

While I’m not rushing to schedule another colonoscopy or additional dentist visits, these experiences have reminded me the importance of scheduling time to take care of myself, unplug, and decompress.  When life gets hectic or I feel myself getting run down, I take an hour or so to treat myself to some pampering or simply take a nap.  I hope that regular attention to my own well-being will mean that I no longer need anesthesia to help me slow down and relax.

Joyful Memories

For the past few weekends we have been bouncing around Philadelphia to all of the free holiday events and enjoying the lights, jingle bells, and hot chocolate at each.  Many of these events are things that we do each year and have become new holiday traditions for our family.  One of my favorites this year though was a morning I spent alone with my son.  Since becoming a family of four, it has become rarer that we get this one-one-one time and there are things that are easier done without a young toddler in tow.  So one day he and I went to the Macy’s Christmas light show together and having my sole attention was good for us both.  On the way home, I asked him what his favorite part was and he said, “lying on the floor and watching the lights, eating the snowman cookie, writing a letter to Santa, and riding the escalator.”  I smiled because that was our whole morning.  Macys

As I finish wrapping gifts and making last-minute holiday preparations, it is memories like this one that make the holiday stress melt away.  While we trimmed our tree weeks ago, with two young children in our house the ornaments are never static.  As they pull ornaments off, we are always redecorating and in doing so, reliving memories.  So this Christmas, I wish you lots of love and laughter with family and friends and a day full of creating memories, big and small.

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Our favorite holiday events in the city:

Macy’s Christmas Light Show

Winter Wonderland at Headhouse Square

FrostFest at Sister Cities

Winterfest at Penn’s Landing

Christmas Lights in South Philadelphia

Merry Christmas!

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