Yes, burnout existed 30 years ago – but how today’s hospital culture is making it worse… aka the “Twitter effect”

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Burnout, burnout, burnout.  It seems like that is all anyone wants to talk about these days.  And I admit, some days, I can get burnt out on burnout.  But, all the attention on the subject got me thinking… did burnout not exist 30 years ago? Why is this such a hot topic now?

And that is what brings me to this post – I came to the realization that burnout very much existed 30 years ago, but that the current “write-up” culture, and what I affectionately refer to as the “Twitter effect”, that is now prevalent in healthcare and most US hospitals has made it infinitely worse.

Let’s face it.  Surgeons have a reputation – bossy, mean, rude, impersonal, hard to work with, and difficult.  And, this reputation, just like Rome, wasn’t built in a day.  It wasn’t even that long ago (during my training years) that surgeons would throw instruments, throw nurses, medical students, even anesthesiologists out of their operating rooms, or yell, scream, and curse to their heart’s content.  Infidelity and extramarital affairs were rampant, paperwork wouldn’t be completed on time, and bad outcomes only had to be discussed at a weekly Morbidity and Mortality (M&M) conference and only with other surgical colleagues.

Clearly, most of the above described behavior is unprofessional, inappropriate, and unacceptable.  But, what it did do was provide a mechanism, a valve so to speak, with which to vent anger, frustration, sadness and fatigue.  And, for a very long time this behavior was viewed as a fact of life.  Nurses would talk amongst themselves, junior residents would get stuck having to operate frequently with the most malignant personalities, clerks and environmental services staff would just look the other way.

But then, over time, we became enlightened.  We became proactive in empowering any and every one to speak up against unprofessional behavior, sexual harassment, or profane language.    We began to focus more and more on ways to measure performance. How long does it take for a physician to complete their paperwork?  How many patients are you seeing in a day compared to your peers?  Hospital complications are now labeled as “never” events.   M&M’s have become Disney World vacations when compared to having to re-live bad outcomes over and over again in hospital-run root cause analyses and peer review sessions to examine the role of the physician in bad outcomes.

But somewhere in all this enlightenment, we have lost the true message of healthcare.  

Healthcare is about relationships, not write-ups.

We have now cultured a culture in which having a bad day, losing one’s patience, or not smiling enough can now lead to getting “written up” by anyone in the hospital – student, resident, nurse, clerk, patient, etc.  The filling out of paperwork, and the careful coding of certain physical conditions so as not to get dinged by the hospital for providing “suboptimal” care, are now fodder for write ups.  Physicians are held captive and measured by the electronic medical record, NSQIP, 360 degree evaluations, and quality metrics.

So what does being written up mean exactly?  It means meetings (often multiple) to discuss said incident or incidents, papers being placed in personnel files, and sometimes poor job evaluations.  I call this the “Twitter effect” – anyone can say anything at all about you, true or false, whether you have worked somewhere for 15 years or 15 minutes… and it gets attention.

Don’t get me wrong here. Professional behavior should be expected at work, and we should always strive to be better physicians, nurses, healthcare workers and humans tomorrow than we are today.

But, punitive attitudes and actions are NOT going to result in any of that.  I have never written anyone up in 11 years, and I pride myself on that because it does not change behavior.

Bottom line, if someone is an a**hole, writing them up is not going to change that.  And, if someone just had a bad day, or is having a rough week, having a relationship with them, being able to engage them in a conversation, will change their future behavior. A piece of paper will not.  Most times, people already know when they messed up, giving it undue amounts of attention only lead to feelings of defensiveness and self-doubt.  And the truth of the matter is bad days happen to all of us.

I am human.  Am I at my best after 36 hours of call inside the hospital with 60 patients on service, back to back emergency surgeries and emotional discussions with families about poor outcomes for their loved ones?  Absolutely not.  But am I still expected to smile, teach residents, make the medical students feel comfortable, get daily paperwork done within 24 hours, have the patience of Gandhi and not make any errors in clinical judgement?  You better believe it.  And, for the most part, I’m 100% okay with that.  I signed up to be a surgeon, I didn’t draw it out of a hat.  However, the feeling of walking on eggshells, the inability to have a bad day, lose one’s patience, or be anything other than perfect is soul-crushing.

I feel this especially as a trauma surgeon.  Surgeons in general are at a national shortage, and especially so with trauma surgeons.  Most institutions are not running fully staffed, leading to more call nights, longer hours, and more fatigue.  And no, this isn’t subjective. Being a trauma surgeon and the amount of call a physician takes have both been directly associated with the development of burnout.

Gone are the days where a surgeon can throw an instrument or curse out an entire operating room… and good riddance, quite frankly.  But also gone are the days in which anyone can have a bad day, get frustrated, or maybe say the wrong thing, and have it understood or handled without a paper trail.  The relationships we form at work are meaning less and less, and paperwork is meaning more and more. And, until we change this – until we change the punitive and negative culture within healthcare – we will continue talking about, and becoming, burned out.

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Organized Surgery Begins to Battle Burnout

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General Surgeon Lifestyles -- Linking to Burnout: Medscape Survey by Carol Peckham March 28, 2013

General Surgeon Lifestyles — Linking to Burnout: Medscape Survey
by Carol Peckham
March 28, 2013

US surgeons are burned out and the numbers are staggering. Whether experiencing emotional exhaustion, depersonalization, or a low sense of personal achievement, 4 in 10 US surgeons exhibit signs and symptoms of burnout. Among neurosurgeons that number jumps to nearly 60%. Burned out surgeons are more likely to report substance abuse, clinical depression, and suicidal ideation. They are more prone to medical errors.

Interestingly, academic practice, trauma sub-specialty, increased nights of call, longer hours worked, younger age, female gender, and small children at home were all risk factors for burnout. For those of you who are new to this blog, I am a female academic trauma surgeon who routinely works long hours and takes in-house call while my small children are at home.

To be clear, these data prove associations and associations do not equal causation; but still, it is sobering to think that so many who entered a profession to fundamentally improve the lives of others are themselves leading such troubled lives due to their chosen occupation.

The occupational hazards of surgical careers are multiple. We suffer moral distress when our patients experience complications or die whether or not an error occurred. We develop compassion fatigue by bearing witness to our patients’ collective and continuous suffering no matter how successful any individual’s outcome may be. Due to our long and often erratic hours, we suffer from chronic fatigue and sleep deprivation. The physical plight caused by fatigue is complicated by many hours on our feet and maintaining awkward postures in the operating room. By routinely putting our patients before ourselves, we often exhibit illness presenteeism. Not infreqeuently, we face the double bind of choosing between being there for our patients or being there for our family. Meanwhile, whether it’s catching up with billing and coding one day, keeping up with meaningful use another day, or spending days studying subjects totally irrelevant to one’s daily practice for maintenance of certification, delivering care in the modern error mandates many a frustrating task that ultimately does nothing to benefit our patients. Furthermore, there is constant fear of litigation that might ruin us in financially or reputationally. And so, it is not surprising that so many of us are burned out.

Emotional awareness (how are you feeling, how does what you are feeling impact your behavior, and how does what you are feeling impact those around you)

All is not dark, however. There are ways for us to be well and resilient. They require both individual effort and culture change. Importantly, they demand emotional awareness. When we understand how we are feeling impacts both our perceptions and our actions, we can act in a way that props us up rather than gets us down.

I was heartened this past week that the American College of Surgeons chose to put surgeon wellness and resiliency on equal footing with the likes of “what’s new in hernia repair” or “ethical challenges in geriatric surgery.” There were a number of educational panel sessions tackling burnout head on. Whether is was about bouncing back in the face of personal loss, gender discrimination, pathways to help surgeons recovering from alcohol abuse back into clinical practice, or managing fatigue, the program was replete with informative sessions on burnout avoidance. Mindfulness, time management, kinship, and down time were emphasized as was physical fitness.

And for the first time ever, the College had a fitness program. As that youngish female academic trauma surgeon with two kids who has struggled with tending to herself after spending her youth, college, medical school, residency, fellowship training, and early years on faculty essentially ignoring personal wellness, I was delighted that this change was happening at my profession’s annual meeting. It was something of a pilot test offering only a very early morning Zumba and a Yoga class, but it was a start. Sure many surgeons at this meeting probably went to the hotel gym or hit the lakefront running path but these efforts happened without the largest surgical professional organization’s imprimatur (hey I even got an American College of Surgeons yoga mat!) or beckoning. These surgeons are likely the 6 in 10 of us who aren’t burned out. But that doesn’t mean we should ignore the self-neglect of our brothers and sisters in the occupation. So this simple step of organizing these fitness events indicated to all attendees that the College both encourages and supports surgeons taking care of themselves. Embed from Getty Images

Making time for fitness has been shown to reduce burnout so I hope the College expands their offerings this time next year. I invite the College to challenge us surgeons to find time for wellness within the already overwhelming conference that offers 5 days of educational sessions geared at making us better surgeons technically and intellectually. The annual Clinical Congress of the American College of Surgeons has essentially had this format the entire time that I have been attending (every year for the past 12 years). With the pilot fitness program the College chose hours and days specifically to not interfere with this typical format. However, given that all the data shows that prioritizing wellness is a key factor in combatting burnout and that wellness takes on many forms, the College should offer multiple offerings–whether it is meditation, or high intensity interval training, or barre, or a knitting circle, or Zumba, or TRX, kick boxing, or spinning, or running– at different times throughout the conference thereby forcing us to prioritize just as I was forced to prioritize between “surgical jeopardy” and “what’s new in body contouring.”

Slide1It will be hard for us to make these choices but we need the practice. I figure its easier to choose wellness when there are no cases to be done or patients waiting in the ER or clinics to be staffed, when there are no lives at risk other than our own.

Refresh for May Day #19: My favorite on demand zit zapper

Like many of you, I wish in my adult life I would never have to deal with the problem of an unwanted blemish. However, I sometimes get an angry red pimple and, while there is really no opportune time to get one, I find that I tend to get one (or more) around the time of special events. Sigh.

  So, to get rid of one as quick as possible I turn to Mario Badescu’s Drying Lotion. I am not a skin chemist so I can’t say for sure, but I think the sulfur is the key to the zit zapping chemical warfare of this potion. It also contains Isopropyl Alcohol, Water, Calamine, Camphor, Zinc Oxide, Titanium Dioxide, Talc, Glycerin, and Salicylic Acid (found in many acne spot treatments). I apply it at night with a Q-tip and by morning the pimple is usually quiescent (or at the very least much easier to hide under some concealer since the camphor and calamine cool the redness quite a bit–or at least I think those are the ingredients responsible for this effect.)

Refresh for May Day #5: Do your breath a favor

Here’s another shout out to oral hygiene.

I have to thank my parents for instilling this habit in me as a child. Of all of the cultural norms I ascribe to because of them, the stainless steel tongue cleaner is the one that plays the biggest impact on my current daily life. While I don’t conduct Hindu prayers, or speak in Gujarati, or eat Indian food in my on a home daily basis, I use this little gem every single day–twice a day in fact.

tonguecleanerEveryone of all cultures should use a tongue cleaner.

Brush teeth. Swipe from back to front with this little gadget a couple of times to uniformly take off any funk lingering on the tongue surface. Rinse.

This process leaves your mouth squeaky clean and your breath fresh.

My husband who had never laid eye on a tongue cleaner until he met me has picked up on this daily habit and totally agrees that using a tongue cleaner is a life long necessity. Once while traveling we left or tongue cleaners at home by accident. We felt gross. We got a weird plastic replacement from a drug store and it did not compete. Since then, I have been hoarding extras, asking friends and family to bring them back from India for me. I make sure I have one in all my toiletry bags (work, gym, overnight) and have extras to boot.

Fret not, however, if you too want to do your breath a favor.  A simple google search will yield any number of holistic websites who are willing to sell you one. I can’t vouch for any so make sure to check merchant reviews first.

Refresh for May Day #3: Ditch you regular toothbrush

For nearly my entire adult life I used a regular tooth brush. A couple of years ago a friend who also happens to be our dentist gifted us a Philips Sonicare toothbrush. The difference in how clean my teeth feel after using this vs a regular toothbrush is amazing. I know this because I share the base with my husband so when I travel I have to resort to the old fashioned way. Between the teeth and along the gum line there is a huge difference. I have found that the hygienist need to do a lot less work on tarter now when I go for my Q6mos cleanings since I made the change. Having a twinkle in your smile and fresh breath without having to adulterate with it with some EtOH heavy mouthwash is a good thing so if you haven’t made the switch to this vibrating, electric, rechargeable toothbrush you should. Your mouth needs this refresh.philipssonicare

Whole30 aka my month of bacon :)

I first learned about Whole30 a few months ago, overhearing my Pure Barre instructors talking about it.  For full details on the plan, click here.  But I will give you the quick and dirty, as well as give you a glimpse of my experience and impressions over the past 30 days.

 

What is it?

It is a diet reset, so to speak, where for 30 days, you eat only “whole” foods.  Similar to Paleo, with some small differences (no honey, agave nectar, or alcohol, which are allowed on a Paleo diet).  It is designed as a type of diet cleanse – to curb cravings and set new, and presumably healthy, habits.  Its primary goal is not weight loss, but healthy eating.

 

What can you eat?

Basically, meat, seafood, healthy fats, nuts, vegetables and fruit without any added sweeteners – and without counting calories.

 

What can’t you eat?

Dairy – cheese, yogurt, milk, etc

Beans – including peanuts and soy

Wheat and flour products – including pasta, rice, bread

Any added sugar – fake or real

Alcohol

 

Why did I decide to do this?

I keep active with exercise, but my diet over the past few months had basically become to resemble that of a 14 year old boy.  Seriously.  My occasional treats had become every day staples.  Although I was still counting calories, it had gotten to the point I could not remember the last time I had eaten a fresh vegetable.  Gummy bears, cookies, Rice Krispies treats and Twinkies had begun to have frequent appearances on my My Fitness Pal logs, and I drank more diet soda than water.  What really sparked me, though, was Pure Barre.  I was in the middle of the Pure Barre Madness Challenge (20 classes in 31 days) and although I was seeing performance improvements, I wasn’t getting any improvements on the outside…. and I realized it was my fault.  Despite all my hard work at the barre, I was basically throwing it in the trash can with my eating.  So, with 10 days left in the Challenge, I decided to go all in, and begin Whole30.

Here I am, Day 30 today, and here is my take…

 

Was it hard?

I remember after chatting with some of the Pure Barre Instructors about this that I thought, “Hell, no.  That sounds too hard.”  But then I realized.  There are certain things in life that are, actually, hard.  What Nelson Mandela did was hard.  Losing a loved one is hard.  Not eating a Twinkie or drinking diet soda for 30 days is not hard.  Did it require some planning?  Sure.  Did it require a change of habits?  Absolutely.  But that was really the point.  So once I got over thinking that this was hard, it made the process a whole lot easier… honestly.

 

How did I feel?

Well, it varied.  Days 1-3 I kept thinking, “what’s the big deal?”… I felt great, wasn’t craving sugar (although admittedly I went through a bit of a sugar binge the day before), and wasn’t that hungry.

However, the constant hunger started about day 4 and lasted until about day 10, when, after chatting with a colleague, I figured out I was still doing it wrong.  Although I was eating all “approved” foods, my proportions were jacked up.  I needed to be eating more fat.  Yep, you heard that right, more fat.  At the beginning, I was too reliant on carbs – fruit, dried fruit (no added sugar), etc.  After understanding more about what my body actually needs, I started to eat more guacamole, cashew butter (occasionally no sugar added peanut butter, see below regarding “cheats”), and more meat.  And, the hunger went away.

Days 13-15 were by far my worst.  I was craving cupcakes, candy, everything and anything.  It was not fun.  Of course, I didn’t plan this well and these days fell over Easter weekend.  Why is this a factor?  Well, because I love Easter candy with an unhealthy passion.  Any of it, and all of it – jelly beans, Cadbury eggs, and yep, even Peeps.  But I stuck to my guns, and didn’t have any…although I *might* have a hidden stockpile of said contraband

Starting around day 16, however, I started to feel great.  No cravings, a ton of energy, and a lot less obsessed with food.

One other physical change I did notice, was that my 3 pm almost daily headaches went away, completely, with no other changes in habits.  Not sure if this was due to dehydration or sugar crash or what, but this was a change that although was unanticipated, was very welcome indeed.

To see Whole30’s version of the timeline, click here.

 

How did I make time for it?

As many of you know by now, my work schedule at baseline is bad, and during this 30 day period it was even worse.  During this 30 day period I only had one day off.  Yep, unfortunately you read that correctly, only one.  The number of meals that I have actually cooked in the six months prior to this you could count on one hand.  Not going to lie, I hate cooking.  But, I knew that cooking was going to be a part of this adventure, so, I planned for two cooking nights a week.  During which, I would cook dinner, then put together a slow cooker meal to go into the refrigerator overnight.  The next morning, all my nanny had to do is empty the container into and start the slow cooker.  So that gave me dinner for the first night, with leftovers the next day for lunch, the slow cooker meal for a dinner and the leftovers from that for another lunch.  Then, the 3rd night it was every man for himself so to speak and I would throw something together just for myself – ex. bacon and eggs, shrimp and veggies.

 

What did I eat?

Some examples of meals –

Spaghetti sauce made with ground beef, mushrooms, onions, garlic, organic tomato sauce, and spices over spaghetti squash.

Slow cooker Korean short ribs with sweet potatoes oven roasted or pan fried with coconut oil.

Taco salad – ground beef with spices, over lettuce with guacamole.

Slow cooker carnitas pork served with over lettuce with guacamole.

Meatloaf without bread crumbs and using tomato paste instead of ketchup.

Slow cooker potroast with carrots, onions, and potatoes.

Slow cooker salsa verde chicken, again over lettuce with guacamole.

Pan fried shrimp and oven roasted cauliflower.

Bacon wrapped dates – which I have been in love with for years, and the fact that I could eat these kept me happy 🙂

Breakfast was usually eggs and bacon with fresh fruit.  So yep, I ate a lot of bacon.

Lara bars – not all of them are compliant, and they do pack a lot of sugar, albeit natural, in them, so I probably had maybe 4 bars throughout the 30 days.

Dried fruit, no sugar added.  Same comment as above, I was eating too much of this at the beginning, and kept it limited towards the end.

 

What did I drink?

Water only.

 

Big question of the day – did I cheat?

Well, yes and no.  Yes in the sense that soy sauce is off limits, and I did use some Worcestershire sauce at one point to marinate the Korean short ribs, and definitely not all of my bacon was organic.  Unfortunately, with my schedule, I just couldn’t prepare every single meal at my house, and I don’t know any hospital in the world that serves organic bacon… But if you find one, let me know 😉  In addition, due to the aforementioned ridiculous schedule, I did have a few scoops of no sugar added, all natural peanut butter.

 

Did I lose weight?

Okay, so this technically was another cheat – you are not supposed to weigh yourself at all during the 30 day period… but I did.  I did not lose any weight for the first week or so, but over the remaining time, I did end up losing about 8 pounds.  May not sound like a lot, there are multiple testimonials out there with people reporting 20+ pound weight loss, but this by far is the most amount of weight I have lost in 30 days in my life and I don’t actually have 20 pounds to lose for full disclosure.

 

What are you going to do on Day 31?

So, when I was perusing the Whole30 timeline about half way through the program, I got to the end, and it stated that most people feel a “twinge of panic” when their 30 days come to a close.  My initial thought, was Ha!  Panic?!  Yeah, right, I am going to not panic my face straight into a cupcake.  However, now that I am actually at the end, I am a bit unsettled as to what I am going to do next.  I don’t want to undo the past 30 days of effort, and I need to balance this with the desire to not go the rest of my life without a Cadbury egg.  Am I going to drop dairy completely?  What about gluten?  Should I designate “cheat days”?  In all honestly, I don’t have this 100% figured out quite yet.  But I have decided to make some changes permanent.  I have decided to drop diet soda completely and stick with water.  I am continuing to plan 2 nights of cooking per week.  I also will continue to eat breakfast every day, something that was pretty rare before starting this program.  My craving for sweets is pretty much gone – at this point, it is more of an emotional desire rather than a physical one, and I think understanding this is crucial to moving forward towards a healthier diet.

 

What are your overall impressions?

This was a great decision, and one that I really needed to make – I feel better, weigh loss, am healthier, without headaches, and have proven to myself that I can make time for some cooking.  I had been trying to lose the same 4 pounds for months, and regardless of any increase in activity, it just wasn’t coming off.  This program really drove the lesson home that weight loss and health in general, is 80% nutrition and only 20% exercise.  You just can’t go and exercise away bad eating.  In addition, my taste buds have definitely been reset – fruit that never tasted sweet to me before now tastes incredibly sweet.  Although this did require some planning, the experience was actually liberating because I wasn’t a slave to calorie counting or food weighing.  I proved to myself that my mind is stronger than I give it credit for, and that I clearly don’t have to give in to any and every food craving.  Overall, I think pretty much everyone could benefit from this, and I would definitely recommend it.

 

Now, I’m off to eat some bacon, and try not to panic about tomorrow, Day 31 😉

 

Pregnancy at age 25 vs 35

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In recent conversations with friends of mine who are pregnant, it became abundantly clear whether this was their first child or third, pregnancy in your 30’s tends to be pretty different than pregnancy in your 20’s.  As a shout out to all my AMA (advanced maternal age) moms out there, and as an attempt to humorously remind people to be sensitive to their friends undergoing fertility struggles (no matter what age!)…

 

Pregnancy at 25:

“Honey, maybe we should start trying for a baby?”

2 days later + 1 fancy digital pregnancy test + 2 margaritas

Embed from Getty Images

 

= “Oh my gosh Honey we are pregnant!”

Embed from Getty Images

 

Pregnancy at 35:

“Honey, maybe we should start trying for a baby?”

8 months + 15 ovulation predictor kits + two visits to a fertility specialist + ovarian reserve blood work + 500 cheapie strip pregnancy tests because those digital ones are so dang expensive

First_Response_Digital_Ovulation_Test

= “There’s still next month…”

 

Pregnancy at 25:

25 minutes after positive pregnancy test, Facebook announcement is made.

Pregnancy at 35:

12 weeks, 3 ultrasounds and genetic testing performed after positive pregnancy test, Facebook announcement is made.

 

Pregnancy at 25:

“Aren’t you a little too young to be pregnant?”

Pregnancy at 35:

“Aren’t you a little too old to be pregnant?”

 

Pregnancy at 25:

Screen Shot 2015-02-04 at 7.49.20 AM

Side view: 8 months pregnant

“Congratulations, when are you due?”  “Next week.”  “Oh, wow!  You barely look pregnant.”  “I know, right?  I didn’t even start showing until I was 8 months.”

Pregnancy at 35:

Screen Shot 2015-02-04 at 7.49.20 AM

Side view: 8 weeks pregnant

“Congratulations, when are you due?” “Oh, about 8 months from now.”

 

Pregnancy at 25:

3 weeks after delivery…

“Honey, where are my bikinis?  I want to take the baby for swim lessons.”

Pregnancy at 35:

3 months after delivery…

“Honey, vintage is sooo popular right now, I swear.”

 

 

Happy babymaking everybody!

 

 

* Ovulation predictor kit photo from http://www.firstresponse.com/products.

My Boobs Don’t Care if “40 is the New 20!”

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I turned 40 this year but I feel healthier and more youthful than I ever I have. With every bit of my being I am trying to live like “40 is the new 20!” (FITNT) I have more cardiovascular endurance. I am taller and leaner (and I just logged in at another 5lbs lighter at my last physical). I no longer wake up with back pain every day. I have better hair (most of which is still not grey). But you know what? My boobs don’t care if FITNT.

So I finally got around to my annual physical. It’s not like I didn’t know what was coming up but I guess I was just in a bit of denial. Also, I basically suck at my own healthcare and have long put off my own health-related action items.

But, according to the American Cancer Society “Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early. However, mammograms also have limitations. A mammogram can miss some cancers, and it may lead to follow up of findings that are not cancer.” And, I have known several friends or colleagues whose first screening mammogram has resulted in an early detection and subsequent cure for breast cancer.

Yup, it was time for these aging breasts to have their first mammogram (luckily I am not in a high risk category). And how it went down has shown me that I might not actually be fully capable of living like FITNT.

1) I call the healthcare system that my PCP is in to book the appointment. I am required to restate every pertinent demographic detail and insurance information that quite obviously should be on file.  Argh the frustation! Since I work in the healthcare system, the scheduler and I bond over the fact that none of our EMRs talk to one another thus creating reams and reams of more ‘paperwork’ for all of us. Perhaps if I were still twenty (and the work was still on actual paper) I would be less frustrated by the inefficiencies that plague my work days. But this middle aged patient just didn’t have the patience for this.

2) MammogramIMG_2985.JPG day. I have to wear a pink gown (pictured). I suppose this should not matter and I get that the color has been adopted by the breast cancer foundations as a way to raise awareness. But we (me and the other patients all lined up in pink gowns) are there to make sure we don’t have early cancers, or see if a suspicious finding may be cancer, or  find out if a past cancer has come back so I would argue that we are not the target raising awareness demographic. So why not just choose a standard hospital issued seafoam green or ocean blue instead of boxing me into a “cancer” frame of mind when I am really hoping that my m? Also, baby girl pink is just not a good color on any grown woman. Twenty year old maybe, but screening mammogram age, no way! Why am I smiling in this picture!?! 

3) Speaking of grown women, I wonder if the mammography techs have a pre-written speech because I had to go twice (the second time to more closely study an abnormal finding that turned out not suspicious) and each time I was asked “What do you do?” And each time, when I responded that “I am a trauma surgeon.” I was asked “Do you like it?” Again, I am a grown woman. You know this because I have told you I am here for my screening mammogram which typically starts at age 40. I am not a twenty year old who just declared her college major which I may or may not like.

4) Oh and about inefficiencies in the healthcare system. I went back for repeat imaging for that abnormal finding <1 business day (and <72 hours of the earth’s rotational time) after the original mammogram. On mammogram day 1, I detailed my menstrual history, my birthing history, my breast health history yet when I returned on mammogram day 2, I was required to re-do all of this. At age twenty I might have just politely complied with this line of repeat inquiry but my forty year old self (especially after the booking annoyance) just didn’t have the fortitude to go through it. I insisted that I had not birthed any additional children or undergone any emergency breast surgeries over the weekend; the rest they would just have to look up.

IMG_29865) ‘But how was it?’ you’re wondering if you too are about to realize that your boobs
don’t care if FITNT. I had the standard 2-view mammogram on day 1. Honestly, though the device looks a bit like Eve from Wall-E to me and the plastic pallet clamping the breast tissue seems decidely more violent than any rated-G movie, the test did not drop me to my knees begging for mercy. Is having your breasts squashed with god knows how many PSI like getting a massage? Umm no. But it was not nearly as violent an experience as I was prepared for. But owee, wowee the extra views needed to rule out that funny finding on for the second mammogram…yeah that took my breath away. I suppose if I still had the dense, perky boobs of a twenty year old, unravaged by the effects many months of breast feeding and the effects of aging, this may have been more comfortable. However, barring very specific high risk factors, those youthful boobs would not need a mammogram.

SadlyIMG_2996.JPG, my aging boobs did; and this whole experience has reminded there are still many ways in which I am decidedly not reacting like FITNT. It seems that with twenty additional years of life, my patience has sagged as much as my breasts have.

 

Why Cris Carter and Janay Rice are Right: From an ex-NFL wife and trauma surgeon

Just because your grandmother did it doesn’t make it right, and husbands can be abused, too.

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This past Sunday, I was absolutely riveted by the NFL Sunday Countdown on ESPN – For those of you who know me and are currently checking the authorship of this piece, yes it is me, surgeoninkicks, writing.

Although I typically would rather watch paint dry than sit through a football show on top of the already vast amount of games I am forced to watch, this past Sunday’s show was different.  Instead of a bunch of talk about who was going to win which game, I sat and watched 5 men of different ages and backgrounds debate discipline, corporal punishment, child abuse and domestic abuse.  With the recent cases involving Adrian Peterson, Greg Hardy, Ray McDonald, and Ray Rice, these topics were debated with intelligence and passion.   And Cris Carter earned my utmost respect as a human being.

Carter: “My mom did the best job that she could do, raising seven kids by herself, but there are thousands of things that I have learned since then that my mom was wrong. It’s the 21st century. My mom was wrong. She did the best she could, but she was wrong about some of that stuff she taught me. And I promised my kids I won’t teach that mess to them. You can’t beat a kid to make them do what they want to do. … The only thing that I’m proud about is the team that I played for [the Vikings]. They did the right thing: take ‘em off the field.”

I’m sorry, but the excuse of, “That’s how I was raised” just doesn’t cut it.  It sure as hell doesn’t work in regards to racism anymore, does it?  If one of your 30 year old friends tries to explain that because they grew up with parents who used racist slurs they are allowed or given a pass to do so, you would cry BS in a heartbeat.

If we lived today how our grandparents lived, we would be using slide rulers instead of calculators, smoking on airplanes, and listening to the radio for our evening entertainment.  Asian people would still be referred to as “Orientals”.  Share cropping and segregation would still exist.  None of these aspects of common, everyday life for our grandparents is common or everyday anymore because we have EVOLVED. We have LEARNED from the mistakes of our past.

Yes, you may be where you are today because of what was done to you, or maybe in spite of what was done to you.  But do not confuse discipline with abuse.  Discipline is teaching your child to respect your authority, not to repeat unhealthy or dangerous behaviors, and to behave responsibly and politely, even when they don’t want to.  Discipline can be and is taught through a variety of methods and techniques.  I’m not going to get into a debate on corporal punishment, but as a surgeon who specializes in traumatic injuries, let me clear up a few things for you.

1.  Discipline does not leave marks on a child’s body.  EVER.  As a physician, I should never see any physical signs or symptoms of your discipline… not the day after, not even the hour after the punishment was given.

2.  Objects should never be used to enforce pain upon your child.  Belts, extension cords, whips, etc.  If you can’t get the point across with the flat palm of your hand or some other method of punishment, then trust me, the belt is not going to fix it.  For those of you who want to say that your child has outgrown your hand, just know that then he or she has outgrown your methods.  Pick a new one.

 

I think almost everyone has seen the video of the argument and physical fight between Ray and Janay Rice, which started before they got into and continued in an elevator in Atlantic City during the offseason.

Janay has been criticized for “regretting” her role in the incident.  I applaud her for that statement.  I am not in her house, none of us are.  But here is what I will tell you.  They have known each other/been dating since high school.  I feel it is a safe assumption they are more mature and hopefully better able to express themselves now than 8 years ago.  I would then lay my next paycheck that this was not the first time either one of them were physical with the other.

No, I am not saying anything was Janay Rice’s “fault”.  What I am saying is that she knows her relationship with her now husband, and who are we to judge if she feels like her behavior incited or escalated the situation?  This IS a possibility.

I do not view physical assault the same as rape.  A woman is allowed to be physically intimate with a man up until the point she is comfortable and allowed to say stop.  But, when a woman hits a man, is it then okay for her to say stop when he hits her back? What if the wife is physically bigger than her husband?  Okay, let’s take it a step further… what if the woman is Laila Ali?  Is she allowed a free punch or two at her husband before he can hit her back?  What if it is a same sex couple?

Battered wife syndrome…100% exists.  I also believe that abusive relationships exist… with both spouses having the potential for being abused.  Unfortunately, I have witnessed firsthand a relationship in which it was the woman who repeatedly pressed buttons, pushed, slapped and provoked her boyfriend until he did physically strike her back.  Then, she cried foul.  And did this stop after one occurrence?  No.  This became a terrible, vicious cycle, which resulted in him luckily losing a girlfriend but unluckily gaining a police record.

Let’s allow Janay Rice to regret a horrible, personal situation, and let’s not allow Adrian Peterson to hide behind, “but that is how I was raised.”

Bottom line, you don’t ever put your hands on another human in anger.  It doesn’t matter if it is your child, your wife, or your husband.

Vacation Set Back Avoidance Summary

A few days ago, we returned from a generously long vacation at Walt Disney World in Orlando. On the heels of a great few days with some of my closest girlfriends, it was nice to also have some quality time with the kids.

Unlike many adults, my husband and I really enjoy the Disney experience. They have truly perfected customer service. Plus, for foodies like us, it is really nice that we can take a week with our kids and still hit some great restaurants. There really is no other place where we could have consumed as many cheese plates as we did with our kids in tow. As much as I have been trying to focus on being fit and healthy, I like food and I like good food. The challenge in my new lifestyle is how to continue pursing foodie habits without huge set backs, in particular during times of travel when the there are so many temptations. During our first family trip to Disney a few years ago, I gained 6lbs that took more than two years to shed. So for this trip there were many salads and much more sharing of appetizers and entrees. I never felt deprived, though. The old me would have been like “Awe, but I might love that and I don’t eat here all the time” and the new me was like “You definitely will not love feeling bloated and tipping the scale a few lbs heavier when you get home.”

Since the place basically forces you to be on the run it is super-easy to log lots and lots of steps it’s another way to balance the food intake which for us was definitely way more indulgent than a given day at home. We averaged 23k-25k steps per day (about 5000 per day less than our previous trip) because the heat drove us to the pool or in for naps or to the gym for a quick workout during the middle of the day. Yes, that’s right. Despite knowing that I would be walking upwards of 20k steps daily, I found time to work out (even if briefly before heading to the parks) every day. Once, I even opted to hit the hotel gym one day instead of a gelato bar.

So, I am happy to report (for those of you who were following my attempts at avoiding a set back until the whole whirl wind of Disney cut into the bloggin time) that after 8 days of a vacation with plenty of gluttony and culinary delights I did not gain weight. Yah!

Check out some more thoughts on my Disney vacay here.