...but the pile of paperwork that awaited me in my office was overwhelming - much worse than usual.
Not sure if it's my imminent departure, solstice or the full moon, but yikes.
Onward. If I don't surface again in two days, call someone to dig me out.
Monday, June 29, 2009
Tuesday, June 23, 2009
Conversations With My Daughter
~ by Jay
Time to get ready for bed, sweetie.
Can I finish my drink?
OK, but come sit down at the table.
{Sits. Notices copy of Brain, Child on table. Opens to debate section: Should We Discipline Other People's Children In Public Spaces?}
So should you?
What do you think?
I think yes and no. Some parents think it's their job to tell their kids what to do, and they might be mad, and some kids would say "I don't have to listen to you".
That's true. It depends on what the kid is doing and whether I know the family, I think.
So like you'd say something to Ari, but not to some kid you'd never seen before.
Well, if the kid I'd never seen before was doing something dangerous, I would still say something.
{Mommy looks at the clock}
You're supposed to be headed up to bed, kiddo. You've stretched this out quite a while.
Strategy, strategy.
Can I finish my drink?
OK, but come sit down at the table.
{Sits. Notices copy of Brain, Child on table. Opens to debate section: Should We Discipline Other People's Children In Public Spaces?}
So should you?
What do you think?
I think yes and no. Some parents think it's their job to tell their kids what to do, and they might be mad, and some kids would say "I don't have to listen to you".
That's true. It depends on what the kid is doing and whether I know the family, I think.
So like you'd say something to Ari, but not to some kid you'd never seen before.
Well, if the kid I'd never seen before was doing something dangerous, I would still say something.
{Mommy looks at the clock}
You're supposed to be headed up to bed, kiddo. You've stretched this out quite a while.
Strategy, strategy.
Monday, June 22, 2009
Jon and Kate plus therapy? ~ by Tigermom
Yes, I watched tonight's episode where Jon and Kate announce they are separating.
Yes, I have a lot of thoughts about this private drama played out all over the press.
Yes, I have more thoughts about the drama playing out in a way so easily accessible to their kids.
No, I will not venture any diagnoses about the why their marriage is taking a break.
But I do wonder, why not try a few couples' therapy sessions?
Two big reasons to try, in my book, that have nothing to do with whether or not they want to stay together or try it apart.
1. For tips about discussing this with the kids.
2. For a little personal insight about relationships so that the next intimate relationship does not play out the same issues.
I wish them all the best and hope they do not hesitate to use therapy as a helpful resource.
Yes, I have a lot of thoughts about this private drama played out all over the press.
Yes, I have more thoughts about the drama playing out in a way so easily accessible to their kids.
No, I will not venture any diagnoses about the why their marriage is taking a break.
But I do wonder, why not try a few couples' therapy sessions?
Two big reasons to try, in my book, that have nothing to do with whether or not they want to stay together or try it apart.
1. For tips about discussing this with the kids.
2. For a little personal insight about relationships so that the next intimate relationship does not play out the same issues.
I wish them all the best and hope they do not hesitate to use therapy as a helpful resource.
Saturday, June 20, 2009
Technology ~ by Tigermom
I think I may blog about this topic a little too often for my taste.
My computer is in the shop for the second time in as many weeks.
Thank goodness I allowed my kids to have use of a good computer when I upgraded mine last Fall. Because for the indefinite future, their computer is all MINE!
My computer is in the shop for the second time in as many weeks.
Thank goodness I allowed my kids to have use of a good computer when I upgraded mine last Fall. Because for the indefinite future, their computer is all MINE!
Tuesday, June 16, 2009
Breaking the Code
~ by Jay
Lauredhel informs us that the AMA considered (and reportedly defeated) a resolution to investigate a code for non-compliance.
(The fact that an American doc learned about this from an Australian blogger will simply be ignored for the moment. And I'd have commented there but WordPress won't let me sign in)
So what's the big deal?
The comments at Hoyden are pretty clear about what the big deal is. If you're coded as non-compliant, what then? Does your coverage get terminated? Since when is non-compliant a diagnosis? The commenters are justifiably enraged at being blamed for not following a doctor's instructions, as if everything the doctor said was handed down at Sinai.
The resolution also lumps "non-compliant" with "abusive and hostile". Lots of people can't or don't do precisely what the doctor asks. Most have perfectly good reasons for that decision - the medication makes them sick, or they can't afford it, or they don't have time to do physical therapy, or their insurance doesn't cover that testing. I suppose a lot of people are "hostile", but when I'm not feeling well and I'm confronted by an impenetrable bureaucracy, I'm usually kind of hostile, too. Very few patients are actually abusive. We need to protect ourselves from truly abusive or threatening behavior, but we shouldn't lump that in with reasonable responses to outrageous stresses.
So what's up with the AMA? Entitled, whiny, doctors with their heads up their assess and their privilege threatened? Partly. I do understand the outrage, and I'm glad the resolution was defeated. I also see a less whiny motivation, though. Insurance companies are holding docs completely responsible for what patients do and don't do, and docking our pay if the patient doesn't follow through. It's called pay for performance, and it's seriously fucked.
Pay for performance sounds like a good idea on the surface: reward the doctors who practice evidence-based medicine and provide care that matches best practices. Since we're capitalists, the "reward" is money, of course. The fucked part comes in how the measurement is done. Standard recommendation: everyone with diabetes should see a podiatrist and an ophthalmologist annually. Everyone with diabetes should have a cholesterol level measured annually. Everyone with diabetes should have their blood sugar at goal. The insurance company used to check to make sure we made the correct recommendations, but now it's pay for PERFORMANCE, see? So the insurance company takes every patient of mine with a diagnosis code for diabetes and checks their records to make sure they also have claims for that patient from the podiatrist, the ophthalmologist and the lab. Then they check my chart to make sure the results are in order. If all the little boxes line up, they pay me some extra money.
But what if the podiatrist's office screws up and doesn't submit the claim? What if the patient is working nights and can't get to the ophthalmologist? What if her blood sugars were in the 300s last year and now they're much better but still not quite at goal?
Doesn't matter. No PERFORMANCE. No cookie for me.
That's no big deal when it's extra money, but it becomes a big deal when it's tied to basic reimbursement (which is already dropping for most of us in the US) and when it's expanded to treatment for hypertension, heart disease and other common ailments. It's a big deal when it's happening at the same time that our patients are losing their insurance or facing much bigger deductibles and copays, making it harder to get to the specialists and the lab.
I'm in favor of evidence-based medicine and practice guidelines. I don't think it's wrong for entities like hospitals and government agencies and even insurance companies to help docs distill information and provide good care. I think physician autonomy has been taken to an extreme in the US, and that the AMA has supported physician autonomy and greed at the expense of our patients. I will never join the AMA; this resolution did nothing to help us work with patients to overcome barriers to getting the care they need. I think they acted out of fear and frustration and, yes, a fair amount of whiny privilege. But I do understand where the fear and frustration came from. There has to be a better way, for all of us.
(The fact that an American doc learned about this from an Australian blogger will simply be ignored for the moment. And I'd have commented there but WordPress won't let me sign in)
So what's the big deal?
The comments at Hoyden are pretty clear about what the big deal is. If you're coded as non-compliant, what then? Does your coverage get terminated? Since when is non-compliant a diagnosis? The commenters are justifiably enraged at being blamed for not following a doctor's instructions, as if everything the doctor said was handed down at Sinai.
The resolution also lumps "non-compliant" with "abusive and hostile". Lots of people can't or don't do precisely what the doctor asks. Most have perfectly good reasons for that decision - the medication makes them sick, or they can't afford it, or they don't have time to do physical therapy, or their insurance doesn't cover that testing. I suppose a lot of people are "hostile", but when I'm not feeling well and I'm confronted by an impenetrable bureaucracy, I'm usually kind of hostile, too. Very few patients are actually abusive. We need to protect ourselves from truly abusive or threatening behavior, but we shouldn't lump that in with reasonable responses to outrageous stresses.
So what's up with the AMA? Entitled, whiny, doctors with their heads up their assess and their privilege threatened? Partly. I do understand the outrage, and I'm glad the resolution was defeated. I also see a less whiny motivation, though. Insurance companies are holding docs completely responsible for what patients do and don't do, and docking our pay if the patient doesn't follow through. It's called pay for performance, and it's seriously fucked.
Pay for performance sounds like a good idea on the surface: reward the doctors who practice evidence-based medicine and provide care that matches best practices. Since we're capitalists, the "reward" is money, of course. The fucked part comes in how the measurement is done. Standard recommendation: everyone with diabetes should see a podiatrist and an ophthalmologist annually. Everyone with diabetes should have a cholesterol level measured annually. Everyone with diabetes should have their blood sugar at goal. The insurance company used to check to make sure we made the correct recommendations, but now it's pay for PERFORMANCE, see? So the insurance company takes every patient of mine with a diagnosis code for diabetes and checks their records to make sure they also have claims for that patient from the podiatrist, the ophthalmologist and the lab. Then they check my chart to make sure the results are in order. If all the little boxes line up, they pay me some extra money.
But what if the podiatrist's office screws up and doesn't submit the claim? What if the patient is working nights and can't get to the ophthalmologist? What if her blood sugars were in the 300s last year and now they're much better but still not quite at goal?
Doesn't matter. No PERFORMANCE. No cookie for me.
That's no big deal when it's extra money, but it becomes a big deal when it's tied to basic reimbursement (which is already dropping for most of us in the US) and when it's expanded to treatment for hypertension, heart disease and other common ailments. It's a big deal when it's happening at the same time that our patients are losing their insurance or facing much bigger deductibles and copays, making it harder to get to the specialists and the lab.
I'm in favor of evidence-based medicine and practice guidelines. I don't think it's wrong for entities like hospitals and government agencies and even insurance companies to help docs distill information and provide good care. I think physician autonomy has been taken to an extreme in the US, and that the AMA has supported physician autonomy and greed at the expense of our patients. I will never join the AMA; this resolution did nothing to help us work with patients to overcome barriers to getting the care they need. I think they acted out of fear and frustration and, yes, a fair amount of whiny privilege. But I do understand where the fear and frustration came from. There has to be a better way, for all of us.
Monday, June 15, 2009
Balance ~ by Tigermom
I meet monthly with a group of therapists with whom I share patients. These are highly intelligent, fun, funny, effective women. Our ages span almost 30 years and we have different family situations.
We rarely get to have real time conversations though we try hard to stay connected about our patients. Typically, I leave a message for the therapist after I have seen one of their patients and they leave me a message if there is something hot going on for a given patient. So I went to my second group meeting today and I love this format. I chafed at the idea of adding more meetings to my life especially once a month. Quarterly seemed more my speed.
But I am liking this. We meet at one another's homes, not in our offices. This fact adds depth to the conversations we have and to the ways we connect with one another. Today started with one therapist's feeling of burnout. What makes her know she is burning out and about what? What are her underlying feelings about her case load and how to dig out of the piles of accumulated work?
I also like that today we met at my house while my kids were upstairs in their pajamas playing video games.
We rarely get to have real time conversations though we try hard to stay connected about our patients. Typically, I leave a message for the therapist after I have seen one of their patients and they leave me a message if there is something hot going on for a given patient. So I went to my second group meeting today and I love this format. I chafed at the idea of adding more meetings to my life especially once a month. Quarterly seemed more my speed.
But I am liking this. We meet at one another's homes, not in our offices. This fact adds depth to the conversations we have and to the ways we connect with one another. Today started with one therapist's feeling of burnout. What makes her know she is burning out and about what? What are her underlying feelings about her case load and how to dig out of the piles of accumulated work?
I also like that today we met at my house while my kids were upstairs in their pajamas playing video games.
Friday, June 12, 2009
I Don't Know What To Say
~ by Jay
About the shooting at the Holocaust Museum in Washington, D.C.
About the death of one of our long-term hospice employees, who passed away at 4:00 PM today, the end of the work week. "Just like her", we all nodded. And wept.
About the American medical system and how broken it is, especially if you suffer from mental illness.
About the men who sat next to me while I finished my lunch, describing in nauseating detail what they would like to do to their female co-worker.
About the playground chants and handgames Eve is bringing home, replete with racism and sexism.
About the prospect of a weekend on call with 12 people on the hospital consult service, 10 in the inpatient hospice unit, and several complex home hospice admissions.
About the absurdity of FMLA forms that do not accept "patient is terminally ill and bedbound" as adequate evidence of need for leave. Whoops, that goes along with "American medical system is broken".
About the death of one of our long-term hospice employees, who passed away at 4:00 PM today, the end of the work week. "Just like her", we all nodded. And wept.
About the American medical system and how broken it is, especially if you suffer from mental illness.
About the men who sat next to me while I finished my lunch, describing in nauseating detail what they would like to do to their female co-worker.
About the playground chants and handgames Eve is bringing home, replete with racism and sexism.
About the prospect of a weekend on call with 12 people on the hospital consult service, 10 in the inpatient hospice unit, and several complex home hospice admissions.
About the absurdity of FMLA forms that do not accept "patient is terminally ill and bedbound" as adequate evidence of need for leave. Whoops, that goes along with "American medical system is broken".
Wednesday, June 10, 2009
Equality ~ by Tigermom
Took younger two cubs out for frozen yogurt at cool new neighborhood place this afternoon.
When eldest cub found out, she made me promise to take her that night too. "You have too; it's not fair that they got to go!"
So, after dinner, I took her out for yogurt too.
I had to get one for myself on each trip. Tried Reeses the first visit because they were out of chocolate. Second trip the chocolate was back in action. "I had to; it's not fair that I didn't get to try the chocolate the first time!"
Ahh, equality.
When eldest cub found out, she made me promise to take her that night too. "You have too; it's not fair that they got to go!"
So, after dinner, I took her out for yogurt too.
I had to get one for myself on each trip. Tried Reeses the first visit because they were out of chocolate. Second trip the chocolate was back in action. "I had to; it's not fair that I didn't get to try the chocolate the first time!"
Ahh, equality.
Sunday, June 7, 2009
What Does It Say About Me....
~ by Jay
That when I see a spam Email with the title "So Deep That The Bottom Could Not Be Seen", my first thought is "unstageable pressure sore"?
Conversations With My Daughter
~ by Jay
Mommy, there's this boy at school who likes me.
Oh?
Yeah, he's one of the cool boys.
What makes them the cool boys?
You know...they wear their jeans real low and baggy and they have those T-shirts on, and they have big belts, and wear caps all the time but backwards.
Oh. And one of them likes you?
Yes. He told Diana, and she told me.
So what does it mean if he likes you?
He wants me to be his girlfriend.
Ah. What do you think about that?
I don't care, really. I mean, he's OK, but I don't know if I really like him.
So what are you going to do?
Oh, I'll probably do it.
Why?
Because I don't want to hurt his feelings.
Sweetie, it's great to have consideration for other people's feelings, but it's not a good idea to become someone's girlfriend just because you don't want to hurt him. You should only do it if you really want to.
Why?
Well, what if you wanted to be Diana's friend, and she played with you and came over to our house and acted like she was your best friend, and later on you found out she just went along with it to keep from hurting your feelings?
I'd be disappointed.
Sure you would. If that happened to me, I might be mad, too.
Maybe.
This is different from playing with someone one time to be nice. If someone wants to play with you and Diana at recess, it's polite to include them, but that's not the same as being someone's girlfriend, or best friend.
No, it's not.
Honey, people teach girls that they should do whatever other people ask them to. I want you to be polite, but you don't have to do things you don't want to do, or things you think are wrong, just to keep from upsetting other people.
What to they teach boys?
They teach boys that they can do whatever they want with girls as long as the girl doesn't say "no". I think that's wrong. I think it's really important that everyone in a relationship says "yes" - it's important to be sure that you're doing what you really want to do, and that you're with the people you really want to be with.
OK, Mommy. I'll think about it.
Oh?
Yeah, he's one of the cool boys.
What makes them the cool boys?
You know...they wear their jeans real low and baggy and they have those T-shirts on, and they have big belts, and wear caps all the time but backwards.
Oh. And one of them likes you?
Yes. He told Diana, and she told me.
So what does it mean if he likes you?
He wants me to be his girlfriend.
Ah. What do you think about that?
I don't care, really. I mean, he's OK, but I don't know if I really like him.
So what are you going to do?
Oh, I'll probably do it.
Why?
Because I don't want to hurt his feelings.
Sweetie, it's great to have consideration for other people's feelings, but it's not a good idea to become someone's girlfriend just because you don't want to hurt him. You should only do it if you really want to.
Why?
Well, what if you wanted to be Diana's friend, and she played with you and came over to our house and acted like she was your best friend, and later on you found out she just went along with it to keep from hurting your feelings?
I'd be disappointed.
Sure you would. If that happened to me, I might be mad, too.
Maybe.
This is different from playing with someone one time to be nice. If someone wants to play with you and Diana at recess, it's polite to include them, but that's not the same as being someone's girlfriend, or best friend.
No, it's not.
Honey, people teach girls that they should do whatever other people ask them to. I want you to be polite, but you don't have to do things you don't want to do, or things you think are wrong, just to keep from upsetting other people.
What to they teach boys?
They teach boys that they can do whatever they want with girls as long as the girl doesn't say "no". I think that's wrong. I think it's really important that everyone in a relationship says "yes" - it's important to be sure that you're doing what you really want to do, and that you're with the people you really want to be with.
OK, Mommy. I'll think about it.
Thanks!
~ by Jay
The current edition of Palliative Care Ground Rounds is up and we're mentioned. Thanks to Angela Morrow, R.N., host of this edition of PCGR.
Thursday, June 4, 2009
Can't Sleep ~ by Tigermom
It is late where I live. I should have been asleep for some time now. I want to sleep. I have early patients. Falling asleep while in session is so uncool. My mind has so many thoughts in there. My mind keeps thinking and thinking. Mostly about things to do, projects I would like to accomplish. Timing of car trips here and there I am due to juggle this weekend.
While in bed I counted to 10 and back again. Several times. I focused on the moment. On being in the present. I focused on my breath. In and out. Filling my lungs and then releasing the air. And then again. And then again. And then again some more.
Then I took half a Benadryl. Then I went back to bed. And I counted to 10 and back again. Several times. I focused on the moment. On being in the present. I focused on my breath.
Then I told myself to do what I tell my patients to do and I got out of bed. I thought about reading a magazine. Or a section of the paper unread on the coffee table.
Then I wondered why am I awake? I am so tired.
I am Jane regular. I fall asleep the same time most nights. I wake up the same time most mornings. I rarely drink. I don't use recreational drugs. My body's rhythms are predictable.
The kids are mostly OK. Tigerdad is overworked, but sound asleep in the next room. My friend with the ill spouse is OK. The ill spouse is no ore or less ill than he has been recently.
I had a killer migraine this afternoon so I had a cup of ... iced coffee to let the caffeine kill the headache.
I think I know my problem tonight. What a powerful drug.
No headache.
And wide awake.
While in bed I counted to 10 and back again. Several times. I focused on the moment. On being in the present. I focused on my breath. In and out. Filling my lungs and then releasing the air. And then again. And then again. And then again some more.
Then I took half a Benadryl. Then I went back to bed. And I counted to 10 and back again. Several times. I focused on the moment. On being in the present. I focused on my breath.
Then I told myself to do what I tell my patients to do and I got out of bed. I thought about reading a magazine. Or a section of the paper unread on the coffee table.
Then I wondered why am I awake? I am so tired.
I am Jane regular. I fall asleep the same time most nights. I wake up the same time most mornings. I rarely drink. I don't use recreational drugs. My body's rhythms are predictable.
The kids are mostly OK. Tigerdad is overworked, but sound asleep in the next room. My friend with the ill spouse is OK. The ill spouse is no ore or less ill than he has been recently.
I had a killer migraine this afternoon so I had a cup of ... iced coffee to let the caffeine kill the headache.
I think I know my problem tonight. What a powerful drug.
No headache.
And wide awake.
Wednesday, June 3, 2009
The View From The Dentist's Chair
~ by Jay
TV in the dentist's office seems like a good idea. You're trapped there anyway, and you can't read or talk, so why not watch TV? It never really works that way for me - I can't see the screen half the time because the dentist's head is in my way, and I don't usually get to choose the channel, and if I do, I never get to see the whole show. It's just background noise, really (although I'd rather have it in the examining room than in the waiting room).
I had a cleaning today, scheduled at 4:30 so I could get a whole day of work in first, and when I sat down and the chair went back, the 4:oo PM Nearby City local news was on. Lots of joking around about summer vacations and plenty of weather and traffic - and then a story about a man who was beaten by a mob this morning. Seems he is the suspect in the rape of a 12-year-old girl, someone spotted him on the street and things got out of hand before the police got there. Tough stuff to talk about - and apparently impossible to report without a racist twist.
The accused rapist is an African-American man, and the mob attack took place in one of the poorer and blacker areas of the city. After the report on the attack and the arrest (only the accused rapist was arrested; none of his attackers were detained), they had a sidebar story on vigilante justice. "People in the neighborhood where the rape took place want to protect their children". The voiceover is followed by are head shots of two African-American men saying that if they'd been there, they would have killed the man, not just beaten him up. "But those who live further away from the original attack are concerned about people taking justice into their own hands". And now we have shots of two white men talking about due process and the need for an orderly justice system. Last is an African-American woman, identified as a professor at a local college, who speaks sympathetically of the desire to take care of ones own but goes on to mention the possibility that well-meaning avengers might attack the wrong man.
Got the message? People of color are violent and don't trust the police. Never mind that the police in this city have a history of ignoring and even inciting violence in black neighborhoods. Never mind that the police "didn't see anything that rises to the level of a charge" in the video of the mob beating. And yes, I know a child was raped - but I also know we put more children at risk by repeating the cycle of violence, and perpetuating the notion that people of color are violent by nature and that whites are removed from the problem.
The cleaning didn't hurt. The TV-watching did.
I had a cleaning today, scheduled at 4:30 so I could get a whole day of work in first, and when I sat down and the chair went back, the 4:oo PM Nearby City local news was on. Lots of joking around about summer vacations and plenty of weather and traffic - and then a story about a man who was beaten by a mob this morning. Seems he is the suspect in the rape of a 12-year-old girl, someone spotted him on the street and things got out of hand before the police got there. Tough stuff to talk about - and apparently impossible to report without a racist twist.
The accused rapist is an African-American man, and the mob attack took place in one of the poorer and blacker areas of the city. After the report on the attack and the arrest (only the accused rapist was arrested; none of his attackers were detained), they had a sidebar story on vigilante justice. "People in the neighborhood where the rape took place want to protect their children". The voiceover is followed by are head shots of two African-American men saying that if they'd been there, they would have killed the man, not just beaten him up. "But those who live further away from the original attack are concerned about people taking justice into their own hands". And now we have shots of two white men talking about due process and the need for an orderly justice system. Last is an African-American woman, identified as a professor at a local college, who speaks sympathetically of the desire to take care of ones own but goes on to mention the possibility that well-meaning avengers might attack the wrong man.
Got the message? People of color are violent and don't trust the police. Never mind that the police in this city have a history of ignoring and even inciting violence in black neighborhoods. Never mind that the police "didn't see anything that rises to the level of a charge" in the video of the mob beating. And yes, I know a child was raped - but I also know we put more children at risk by repeating the cycle of violence, and perpetuating the notion that people of color are violent by nature and that whites are removed from the problem.
The cleaning didn't hurt. The TV-watching did.
Tuesday, June 2, 2009
Things I Can't Do
~by Jay
Lurk on a listserv.
Talk to a drug rep without feeling overwhelmingly angry.
Pick up a cereal box without reading the back.
Start a mystery series in the middle.
Listen to ABBA without singing along.
Lie to my mother.
Sit in the lotus position.
Talk to a drug rep without feeling overwhelmingly angry.
Pick up a cereal box without reading the back.
Start a mystery series in the middle.
Listen to ABBA without singing along.
Lie to my mother.
Sit in the lotus position.
Leaving the Practice
~by MPJ
Jay's posts about leaving her practice for a new position, have had me thinking about the last time I heard the words "left the practice." For many years, I didn't have a gynecologist. My primary care physicians did my annual exams, which were fairly straightforward. I started appointments with an OB/GYN practice when I got pregnant with my son, but, for a number of reasons, decided to leave after his birth.
My primary care physician recommended a few doctors in a different practice, which she said was really exceptional. When I called to make an appointment, I was told that none of the female doctors were taking new patients. Would I be willing to see a man, the receptionist asked. Hm, well, I shouldn't judge people by their gender now, should I? And yet, I generally insist that everyone who comes into professional contact with my body -- from my hairdresser to my dentist to my dermatologist to my primary care doctor -- be a woman and I vastly prefer it that way. (Why is another blog post, I think!) But this time, I thought, ok, I'll give it a try.
So, a few weeks later, sitting there in my paper robe, I met Dr. Smooth. He was young, shockingly handsome and had an exotic and dead sexy accent. In a situation in which my sexual organs were being examined, I found it awkward to find myself confronted by my doctor's radiant sexuality.
After the exam, a fully dressed me met him in his office to discuss birth control options. On his desk was a picture of himself with a stunning, model-worthy blonde woman. And I couldn't help but wonder about her and how she felt about her husband (or boyfriend or fiancé) doing breast exams and looking at other women's vaginas all day. Then I thought, that's terrible, this man is a professional. Which was followed quickly by the thought, but what made him want to take up a career that involved feeling breasts and looking at vaginas all day? And I replied to myself, the miracle of life! bringing babies into the world! he just wants a nice upbeat doctoring job! To which the other voice replied, yeah, a nice upbeat job touching breasts and vaginas.
I told Dr. Smooth that I was thinking about trying the pill. And he told me that was an excellent option because it made sex so much more spontaneous and enjoyable. Um, ok. That was weird. Still, talking about sex was part of the job, right? He wrote me a prescription and off I went, feeling uncomfortable.
The next time I called for an appointment, the receptionist informed me that Dr. Smooth had left the practice, but a new doctor, Dr. Joan Saintly, was taking his patients. Would I like to make an appointment with her instead? There had been no warning and no information about where Dr. Smooth had gone or when or why. And I couldn't help but think when the receptionist said "left the practice" that what she really meant was "was forced to leave due to sexual misconduct." I've always wondered, would I have made the same assumption about any male doctor? Any handsome male doctor? Any doctor who talked to me about enjoying sex?
Dr. Saintly has been my gynecologist for seven years now. She's my favorite doctor. Ever. She delivered my daughter. She tested me for STDs and listened to me sob when I found out about my husband's addiction. She performed my abortion and listened to be sob some more. I've never felt awkward with her. I've never wondered why she started practicing as an OB/GYN. (Although I am so thankful she did.) I do sometimes wonder how much of the difference between her and Dr. Smooth is due to gender. But all I really know is, if she left the practice, I'd break down in tears, just as Jay's patients have.
My primary care physician recommended a few doctors in a different practice, which she said was really exceptional. When I called to make an appointment, I was told that none of the female doctors were taking new patients. Would I be willing to see a man, the receptionist asked. Hm, well, I shouldn't judge people by their gender now, should I? And yet, I generally insist that everyone who comes into professional contact with my body -- from my hairdresser to my dentist to my dermatologist to my primary care doctor -- be a woman and I vastly prefer it that way. (Why is another blog post, I think!) But this time, I thought, ok, I'll give it a try.
So, a few weeks later, sitting there in my paper robe, I met Dr. Smooth. He was young, shockingly handsome and had an exotic and dead sexy accent. In a situation in which my sexual organs were being examined, I found it awkward to find myself confronted by my doctor's radiant sexuality.
After the exam, a fully dressed me met him in his office to discuss birth control options. On his desk was a picture of himself with a stunning, model-worthy blonde woman. And I couldn't help but wonder about her and how she felt about her husband (or boyfriend or fiancé) doing breast exams and looking at other women's vaginas all day. Then I thought, that's terrible, this man is a professional. Which was followed quickly by the thought, but what made him want to take up a career that involved feeling breasts and looking at vaginas all day? And I replied to myself, the miracle of life! bringing babies into the world! he just wants a nice upbeat doctoring job! To which the other voice replied, yeah, a nice upbeat job touching breasts and vaginas.
I told Dr. Smooth that I was thinking about trying the pill. And he told me that was an excellent option because it made sex so much more spontaneous and enjoyable. Um, ok. That was weird. Still, talking about sex was part of the job, right? He wrote me a prescription and off I went, feeling uncomfortable.
The next time I called for an appointment, the receptionist informed me that Dr. Smooth had left the practice, but a new doctor, Dr. Joan Saintly, was taking his patients. Would I like to make an appointment with her instead? There had been no warning and no information about where Dr. Smooth had gone or when or why. And I couldn't help but think when the receptionist said "left the practice" that what she really meant was "was forced to leave due to sexual misconduct." I've always wondered, would I have made the same assumption about any male doctor? Any handsome male doctor? Any doctor who talked to me about enjoying sex?
Dr. Saintly has been my gynecologist for seven years now. She's my favorite doctor. Ever. She delivered my daughter. She tested me for STDs and listened to me sob when I found out about my husband's addiction. She performed my abortion and listened to be sob some more. I've never felt awkward with her. I've never wondered why she started practicing as an OB/GYN. (Although I am so thankful she did.) I do sometimes wonder how much of the difference between her and Dr. Smooth is due to gender. But all I really know is, if she left the practice, I'd break down in tears, just as Jay's patients have.
Silence Is The Enemy
~ by Jay
Trigger warning
I receive medical publications every day - journals, leaflets, advertising circulars, newspapers, CME brochures. Most go directly into the recycling; a few land on my overflowing to-be-read pile. Every now and then I pick one up and leaf through it, but I don't have time to stop and actually read - except for that one day in 2005, when this issue (link goes to pdf) of The Medical Encounter showed up and I found myself drawn to the story Roses Don't Cry.
Because silence is the enemy. Silence allows the cycle to continue. Silence is alliance with the perpetrator.
I'm one of the lucky ones. I only have to read about childhood sexual abuse, and occasionally hear about it from my patients. I don't have to remember it, don't have to be reminded of it every time my husband touches me, don't have to wake up at night in the sweat of a flashback dream. I can turn the page or close the exam room door and pretend it doesn't exist. Zuska and Isis don't't have that luxury. Today, they are naming their own experiences to help girls thousands of miles away.
Liberia's civil war is over, but the epidemic of rape continues. Nicholas Kristof wrote ‘it has been easier to get men to relinquish their guns than their sense of sexual entitlement.’ I'm sure millions of people read those words, shook their heads, and turned the page. Sheril Kirshenbaum at The Intersection decided to do something, and this is the "something" - a day of blogging to draw attention to the plight of girls in Liberia, and a month of blog revenues donated to Doctors Without Borders.
These stories are painful to read, and I want to turn away. Sometimes I do. But sometimes I use my luck and my privilege to act as an ally for those who cannot speak and cannot turn away. This is one of those times.
Silence is the enemy.
I receive medical publications every day - journals, leaflets, advertising circulars, newspapers, CME brochures. Most go directly into the recycling; a few land on my overflowing to-be-read pile. Every now and then I pick one up and leaf through it, but I don't have time to stop and actually read - except for that one day in 2005, when this issue (link goes to pdf) of The Medical Encounter showed up and I found myself drawn to the story Roses Don't Cry.
Clenching her teeth, she closed her eyes and told herself sheWhat was this vivid description of sexual abuse doing in one of my journals? Why did I have to read this horrifying thing in the middle of my busy morning?
didn’t have to be afraid. She wasn’t there. She was inside the
wallpaper … another rose, hiding among the roses. Some
other little girl sat on top of him, her wet panties and sundress
laying rumpled on the floor. Not Angel. She wasn’t bad like
him.
Because silence is the enemy. Silence allows the cycle to continue. Silence is alliance with the perpetrator.
I'm one of the lucky ones. I only have to read about childhood sexual abuse, and occasionally hear about it from my patients. I don't have to remember it, don't have to be reminded of it every time my husband touches me, don't have to wake up at night in the sweat of a flashback dream. I can turn the page or close the exam room door and pretend it doesn't exist. Zuska and Isis don't't have that luxury. Today, they are naming their own experiences to help girls thousands of miles away.
Liberia's civil war is over, but the epidemic of rape continues. Nicholas Kristof wrote ‘it has been easier to get men to relinquish their guns than their sense of sexual entitlement.’ I'm sure millions of people read those words, shook their heads, and turned the page. Sheril Kirshenbaum at The Intersection decided to do something, and this is the "something" - a day of blogging to draw attention to the plight of girls in Liberia, and a month of blog revenues donated to Doctors Without Borders.
These stories are painful to read, and I want to turn away. Sometimes I do. But sometimes I use my luck and my privilege to act as an ally for those who cannot speak and cannot turn away. This is one of those times.
Silence is the enemy.
Monday, June 1, 2009
And So It Begins
~ by Jay
Every fifteen minutes I make someone cry.
I need to tell you that my last day in the practice will be July 10th.
OK, they don't all cry, but enough of them do - or look devastated even without tears - to leave me feeling like a limp dishrag already, at 1:30 the first day.
It's going to be a long, long six weeks.
I need to tell you that my last day in the practice will be July 10th.
OK, they don't all cry, but enough of them do - or look devastated even without tears - to leave me feeling like a limp dishrag already, at 1:30 the first day.
It's going to be a long, long six weeks.
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