Oh Hello, Fourth Year…

I’ve finally buckled down and started studying for Step 2 CS, the third of four USMLE “Step” exams we have to take to be a fully licensed physician. So far I’d say it’s going as well as can be expected…

I plan on taking the test at the end of June and having a week off before fourth year starts.

On that note, holy wow – when did fourth year become weeks away? Our fourth years have been doctors for 2 weeks now, which makes my class the next in line for graduation.

While we’re on the subject of graduation, let’s talk about something I saw while doing a little perusing on Pinterest today (you know…while I was…studying…):

Medical School Graduate Gifts 

Now, I’m sure this is a great blog (actually, I’m not sure seeing as I can’t read a lick of Turkish, but we’ll give them the benefit of the doubt), but they have totally missed the mark on this one.

Let’s put it this way, do not buy any of that crap for your med school graduate. Just don’t. 

Actually, there are some adorably decorated cookies or something on there as well. I’m pretty sure anyone who isn’t diabetic or lactose intolerant can appreciate some delicious iced sugar cookies, so that one I’ll make an exception for…you can buy them cookies.

But please forego the X-Ray iPhone cover, Caduceus tie and super creepy doctor trophy.

Along the same lines, I’d probably stay away from stethoscopes, speculums and pen lights.

If you feel so compelled as to buy your medical school graduate something, take advice from this more appropriate Yahoo article and go with a something useful – like a Hep B vaccinated house keeper to clean their house (which likely still has dirty anatomy scrubs and scalpels laying in the back of a closet somewhere) or money to put towards the outrageous debt they’ve become blissfully married to over the past four years.

Or a car, that’d be a nice gift, too.

But seriously, a Starbucks gift card is probably your best bet for winning over your future intern.

The Reply-All Button Ruins Lives

I like to give people the benefit of the doubt and assume that in 2012 everyone who has an email address understands the difference between a “reply-all” button and a “reply” button. Unfortunately, I am discovering this is not the case and, as such, feel it is my moral duty to inform you all that reply-all can ruin your life (and annoy the snot out of me) when used incorrectly.

So, what’s the difference?

Reply: Sends an email response to the original sender of the email.

Reply-All: Sends an email response to all 28 people who received the initial e-mail.

And what’s the problem?

Let me set up a scenario for you:

Jim sends an email to the whole company, including me, your aggravating, lunch-stealing, once-a-week showering boss, discussing all the nitty-gritty details of the meeting I’m holding Friday that will likely cut into your lunch time. He explains that we won’t be having lunch during the meeting due to recent budget cuts around the office.

You, my frustrated, overworked, underpaid, reasonable employee decide you’ll respond with a complaint to your mutually disgruntled friend, Jim, about said meeting and me, your horrible boss.

You Reply:  Message goes to Jim. Jim laughs. Jim responds. Your worries and annoyances are aired. You feel better to have vented.

You Reply-All: Message goes to Jim…and 14 other people you work with, including me, your smelly boss. You feel better to have vented. You lose your job. You are unemployed. Your dog starves to death, because you can’t afford food for him.

Conclusion:

The Reply-All Button Ruins Lives…and threatens the lives of animals…particularly when used inappropriately. It would beheave you to take note of this Public Service Announcement. Thank you for your time.

Breaking The Rules

A recent article called “To Tweet, or Not To Tweet: Physicians Misusing the Internet” discussed a new JAMA study which apparently found that…

“92 percent of state medical boards in the United States have received reports of [online] violations ranging from inappropriate contact with patients to misrepresentation of credentials.”

I guess this is supposed to be shocking, but I was really somewhat underwhelmed with the information (I was actually more shocked it wasn’t 100% – which state has had none…because that’s awesome). It’s exceedingly easy to report a violation that occurs online, since it’s permanently etched in the history of the internet, so of course there’s a large number of state boards receiving reports on violations that occur online.

The discussion is relevant and interesting, but clearly written with a negative attitude and watch-your-mouth, paternalistic tone (like many of the recent articles and research publications on social media in medicine, unfortunately). A quick search finds that the doctor on the answering end of this Q&A session has a rarely used Twitter account (@RyanGreysen) and no blog (that I could find, anyway)…clearly making him one of the least effective people to be discussing these issues unless his only advice is going to be to avoid a presence in social media all together.

However, that’s not exactly the point. What irks me so much about the recent onslaught of negative-nancy articles on physicians in social media is that they pretend that the internet is some delinquent hangout for the physicians who can’t seem to conduct themselves professionally. The tone of these articles comes across like Twitter is where we gather to join in HIPAA-violating hippie parties and have inappropriate contact with patients.

The tone implies that these things don’t happen on the elevator, at the football game or in the corner bar. The article (and many others like it) repeatedly discusses the need for educating physicians on the “rules” of online behavior and “how to conduct yourself online.”

That is not the problem.

The fact that the online world documents breaches is the problem.

Venture into any hospital hallway and you will be bombarded with far more private information in a circle around one ward than you will in a full days Twitter stream.

The issue is not that we’re gathering online and violating HIPAA because we don’t know how to conduct ourselves online, the issue is that it’s recorded here.

By saying we should educate physicians on how to act online we imply that either:

A) Unprofessional conduct is not occurring off-line.         OR

B) It’s more important to watch what you say here because it’s documented.

 

Is it important to watch what you say here because it’s documented?

Absolutely. Unequivocally. Yes.

Is it more important than it would be in your local Chili’s?

I sure hope not.

 

Sure, you’re less likely to get caught if you’re talking about private patient details in Chili’s, since it’s not being recorded and all, but that doesn’t make it ok. As a kid my mama would tell me,

“Doing something bad when you know you won’t get caught doesn’t make it any less bad.”

Doesn’t that rule still hold true?

What I’m saying is that these are not separate entities. Just because reports aren’t getting filed about physicians discussing private patient details in elevators as often as they are about physicians discussing private patient details online does not mean it’s happening less. It means it’s recorded less. That is not to say that there is no room for guidelines or advice about conduct in social media, just that online behavior is not inherently different than offline behavior. @SeattleMamaDoc really said it best,

“We are worse in the elevator than we are online.”

We don’t need to educate physicians on behavior online, because this problem is not unique to the internet. We need to educate physicians on keeping private patient information to themselves. On using some common sense and respecting co-workers and patients alike. Not just on the internet…everywhere…including on the internet. The physicians who are violating privacy and acting unprofessionally in the elevator are the ones who will talk about their patients online. This is not a problem inherent to an information medium, it’s a problem inherent to a person. And I’m not sure it’s one that can just be “educated” out of someone.

Thus, this is not about our online conduct, it’s about our conduct…and as soon as we make it about online conduct we imply that it’s only important to follow the rules if there’s a really good chance you’ll be caught if you break them.

 

Image 1: Pixomar | FreeDigitalPhotos.net

First: Do No Harm…Even To Colleagues?

Like many others I recently read a New York Times Op Ed piece entitled “Don’t Quit This Day Job,” written by Dr. Karen Sibert and I was immediately taken aback by what she had to say. I wanted to write this several days ago, but as anyone who has spent half a second perusing my blog or Twitter knows, I’ve been severely busy losing my mind for the past several weeks.

The first thing that struck me about this piece was not that she was stating her opinion, but that she chose to take the route of justifying her opinion by saying that medical education was “subsidized” by the government and women working part-time were the reason there was a shortage of physicians. She took two hugely complicated and multi-faceted issues, chiseled them into pawns that worked for her argument and held them up as shields for her below-the-belt shot at other women, all the while ensuring she herself came off as the martyr.

What I don’t understand is where she gets her basis for blaming the physician shortage, a crisis we can all agree did not start yesterday, on women working part time. She states that the part-time work force has grown 63% since 2003...two-thousand-three
…meaning, people started going part-time in large quantities well after we had identified that there would be a primary care physician shortage. There is so much more to this problem – to take a national platform like the New York Times and use it to place the blame for such a massive, cumulative problem on women working part-time is wholly and incredulously irresponsible.


It is ironic she chose to point her finger only at part-time women physicians with children, as if there are no men who are part time for their kids or no people of either sex who are part-time for other reasons (like research, academia, continuing education, volunteering, writing books or NYT Op Ed articles scaring females out of medicine, etc.).

Her choice to blame part-time women in particular makes it obvious that this article is less about the physician shortage or lack of healthcare and more about pointing her “you are weak” finger of medicine at the new generation of physicians and standing up on a pedestal to wave her holierthanthou
flag.

As a current female medical student I am well aware that medicine is a field in which it will be difficult to find a work-life balance. Coming into this we are not jaded to the fact that work-life balance is hard, nor are we ignorant to the fact that the generations of physicians ahead of us view medicine differently than we do. Dr. Sibert brings up some great points in her piece, but spends most of her time blaming this or that on other people.


Saying it is hard to find life balance is not the same as placing a blanket statement over women that they should not go into medicine if they are not going to work full-time. For one, it’s irrational – many medical students start medical school unmarried and not considering children…those people have no idea where life will take them in the next 10 or 15 years – life can change drastically in that time. Dr. Sibert judged an entire group of women whose lives have not been as easy as hers – women who went to medical school and decided they wanted kids but didn’t have the help she obviously had. She chose to use her platform as a place to pin these women as being less strong or less dedicated than she, while overlooking that you can be dedicated to medicine and still put your family first.

What is obvious in her writing is that Dr. Sibert either had the luxury of a nanny to raise her kids or had a husband and family who could pick up the slack when she was working “full-time.” It’s easy to judge from that side, when you’ve never lived 400 miles away from your entire family, been a primary care physician who didn’t make enough money to hire a full-time nanny, found yourself suddenly a single mother or the parent of a child with a disability requiring full-time assistance…or simply decided your family wasn’t going to be put on the back burner.

It was irresponsible and unfortunate for her to choose to address a subject warranting so much discussion by placing the blame of the current physician shortage on women who work part-time. Where she could’ve stimulated productive conversation, she instead shattered alliances and discouraged female physicians. Her words are absolutely and incredulously wrong and her assumption that these women are less dedicated to their profession is blatantly out of line. The blame for the physician shortage doesn’t go to part-time women, it goes to a culmination of events that have played out beginning many years ago and including, but not limited to, decisions made by politicians.



It is commendable, from a professional perspective, that Dr. Sibert has chosen to work full-time. However, it is also commendable from a parenting perspective those that have sacrificed themselves to do what they felt is right for their children. These are not situations requiring blame or shame, they are choices. Dr. Sibert is blessed to have a job she loves and a family with enough support that she can work full-time in that field. Many of the “part-time” women she is referring to still work 40 hours/week…an amount considered full-time by most all standards. They are doing the best they can – for their patients, their family and their colleagues – they don’t deserve the blame given.

If nothing else Dr. Sibert has done a supreme job of building a huge wall between her generation of physicians and my generation of physicians when we need their mentoring and guidance the most. We aren’t here to be judged, we’re here to live our lives and learn how to be the best doctors we can. From there, we will make the best decisions we can to ensure we stay good physicians by maintaining not only our skills, but our personal mental and physical health…even if that means less hours per week than Dr. Sibert. It saddens me that she has discouraged potentially great future female physicians from choosing medicine as a career path and, frankly, I expect more out of her as a woman, a mother, a mentor and, mostly, as a colleague.


Images Courtesy of Sura Nualpradid.

All Helmets Are Not Created Equal

I really thought this was common sense…

Had I not just written a post about parents knowingly putting their young children in danger’s way, I would write a long and judgmental blog right now about how I wanted to yell obscenities at a father yesterday while taking a leisurely walk with my husband and our dogs. Instead, I’ll just tell you what I saw.

A man riding a dirt bike through our neighborhood (Strike 1 – Not a street legal bike) with his toddler-age son (Strike 2 – Not a double occupancy bike) who was wearing a foam bicycle helmet (Strike 3 – Not gonna help much your child flies 100 feet and lands head first on the pavement). 


Let me end this by saying that I am in no way anti-motorcycle. I grew up riding and racing dirt bikes and ATVs and I think they are a lot of fun, albeit inherently dangerous, when used in the right context and with appropriate safety equipment. My dad has a gorgeous red Harley and he loves it, but I’m not sure I could ever get on one again…after working in the ER they scare the bejeezus out of me 
 (on that note, dad – please for the love of God get a helmet for that thing). If you want to endanger your life, then that’s your choice but please, use your brain when operating heavy machinery and think twice before putting your child’s life at risk.

Kids For Dummies

Being as I’m neither a parent nor an expert in the field of parenting, it’s not very often that I’m ready to judge someone’s ability to parent. However, occasionally something happens that makes me wish there were legal forms requiring a signature from a doctor, lawyer and priest before one could utilize their reproductive organs.

When I pulled up the red light I was so busy trying to figure out why my favorite radio station wasn’t coming in that I paid no attention to the vehicle next to me. Then, using my super hero-like peripheral vision, I noticed the passenger side window of a bright red mustang rolling down and it caught my attention. It’s cold outside, why in the heck are they rolling down the window?


When I looked over I really expected to see someone tossing a McDonald’s bag or ashing their cigarette, in which case I promptly would have rolled down my window and screamed one of the following before speeding off in a cloud of dust:

  1. YOUR BODY IS A TEMPLE.
  2. YOU’RE GOING TO GET CANCER.
  3. PROTECT THE ENVIRONMENT!
  4. DON’T MESS WITH TEXAS!
  5. PICK THAT UP RIGHT NOW, YOUNG MAN. 

Instead of sharing my obviously judgement thoughts with the world, I sat speechless with my jaw in my lap when I saw neither McDonalds nor Marlboro tumbling out the window…


No, what I saw coming out of that window was the tiny fingers of an adorable blonde-headed little boy. A three-ish year old in the front seat of a Mustang, leaning on the dash, rolling down the window and sticking his hands out to wave at me…all while dad tells the other end of a cell phone about last night’s American Idol premiere.

Dad noticed the window was down and rolled it back up just in time for them to speed off ahead of me when the light turned green. About a mile up the street I was going around 52 mph and they were a good ways ahead of me, so let’s be generous and say they were going 60 mph (which is 10mph over the speed limit in this area, but if you don’t buckle in your 3 year old I’m not entirely surprised when you are speeding with one hand on the wheel and one hand fixing the sun visor your unrestrained child was just hanging off of).

For some perspective, watch as this unrestrained three-year simulation child flies almost through the front window after a crash at 30mph (!!!!) and sustains what the narrator describes as “most likely fatal injuries.”

I follow a few heartbreaking blogs of amazing women (“From IF to When,” “Got Love – Been Married – Now, Where the Hell’s The Baby Carriage?,” “Many Many Moons,” “Seriously?!” – I could go on and on) who would LOVE the opportunity to buckle their child in, while this parent carelessly risks the life of theirs.

There are so many fabulous couples battling infertility who would do anything for the chance to safely strap a baby into a rear-facing car seat or booster seat in the back of their car, while this guy practically asks for his child to be taken away from him.

Why, with all the knowledge we have about child safety, do people still risk the lives of their kids like this? All it takes is one blown tire or one quick glance off the road to change your life entirely…to end your life entirely…to end your child’s life entirely. 

So, while I don’t honestly think that there should be consent forms before someone has a child, I wish that parent’s would understand the magnitude of the choices they make. I wish that people who were going to be bad parents just wouldn’t ever get pregnant and that people who would be absolutely wonderful parents wouldn’t have to fight the frustrations and heartache of infertility. 

I guess all I’m saying is I wish the world was a more fair place…and I wish I could protect kids like this from the consequences of the choices their parents make. 

It’s Because I’m Green, Isn’t It?


If I had a dollar for each time someone has called me cuddly-as-a-cactus since my previous post I’d have a million dollars. Okay, that’s a total lie – I wouldn’t have any dollars (which is not so different from the amount of dollars my bank account has, so I’m in good company), but I did feel very judged after admitting my aversion to Frosty the Snowman. 

So, in attempt to reconcile with my audience the four of you who read this and with my family (Christmas is here, there are gifts that will require my acceptance) I will explain myself further.

“How do you hate Christmas music? I LOVE this time of year.”
Whoa, whoa, whoa. Hold yir horses there cowboy. I didn’t say I hate Christmas or this time of year. Au contraire grasshopper, I love almost all (non-musical) things Christmas and I greatly enjoy this time of year. In fact, making, sending and receiving Christmas cards has to be one of my favorite things ever. This year we actually had a wonderful photographer, who also happens to be a wonderful friend, take some “family portraits” for us.
If you follow me on Twitter you know I am ridiculously happily married to my (intensely handsome and exceedingly geeky) college sweetheart and we have three children crazy dogs. We have been a “family” for almost 3 years now and despite having an absurd amount of pictures of our dogs, we have no pictures of all 5 of us. So, I decided Christmas cards would be a divine excuse to obtain such a picture. I mean, if we’re going to force our friends and family to look at pictures of us and our hairy children, they might as well be good pictures, right?
So, in my giddiness to create Christmas cards I contacted my friend and we had a little photo shoot. I peed my pants the day our cards came in the mail. Unfortunately, it seems not everyone gets this delighted to send and receive Christmas cards. My cognizance of the Christmas Card Haters was born following a riveting conversation I had at a local drug store:

Me: “Are there 20 stamps in each booklet? I think I need two sets.”

Checker: “Yeah. What do you need so many stamps for anyway?”

Me: (Alright meddling woman, I’ve been looking for stamps for an hour….freaking sell them to me so I can get on with my life.) “To mail our Christmas cards.”

Checker: “WHAT!? This is a LOT of money to spend on Christmas cards. You should just send a text. My Christmas card is a mass text to my friends.

Me: (WHAT is wrong with your my generation!? Snail mail is dead and part of my heart has died with it. You kids and your new-fangled mePhones and weemail….pick up an ink pen dagnabit) “Thanks, Merry Christmas. I’ll text you.”  

Merry Christmas, Friends – With Love From The Joneses
Danielle, Donnie, Wrigley, Sage & Mae
More photos and hilarious blooper shots on our post at Linda Schillberg’s blog



So, rest assured hollyjollychristmasers, that I know how you feel when you tell me it makes your peanut brittle to hear that I hate Christmas music. I felt like I’d be given a stocking full of coal when I discovered there was a breed of folks out there who hate Christmas cards. The only thing I love more than designing and sending our Christmas cards is receiving cards from our friends and family.

Some of the cards we’ve received from friends & family this year.
Tell me, readers, what do you think of Christmas cards? And please tell me you aren’t mass texting your friends and family as their holiday greeting….I need my faith in our generation restored. 


La La La I Can’t Fa La La Hear You

I have a confession to make.

Every, single year it happens in November, typically on the day after Thanksgiving, but occasionally before the wonderful day of food giving thanks. It usually begins on a lonely, silent night when ye merry gentlemen are just settling down for some rest. Without fail it will catch me off guard like a bell jingling during a dream about how December 25th might turn out to be white this year or while I’m busy offering a cup of cheer to my neighbor. Yes, I have to ask, do you hear what I hear?

Original Photo Courtesy of Striatic on Flickr.

Hark! I hate Christmas music.

It’s true. I despise the songs of the holidays. I abhor them even more than I hate those little pieces of fuzz that end up all over my dryer every time I clean the filter thing out. More than I hate grocery baskets being left in parking lots so they can bang into my car. I almost hate them as much as being asked if I’m wearing my husband’s jacket, but that’s pushing it a little.


Every time someone joys to the world at the grocery store or holly-jolly-christmases on my radio red and green goo starts seeping out of my ears. Then I change the station to no avail. It’s everywhere. It’s like the FM carolers are sitting in my passenger seat overflowing with Let It Snows to propel in my direction. 


I don’t know what it is. Maybe it’s because the music is so effing jolly. Or maybe it’s because I can’t get away from it. Or maybe it’s because I really prefer to listen to music in my car that doesn’t get burned into my brain for 6 hours after I’ve killed the engine. Whatever it is, it makes me shudder. You know that feeling you get when you ask a not-pregnant lady when her baby is due? You know, like you need to run really fast in the opposite direction and not stop until her wails of cursing can’t be heard anymore? No? Well, whatever makes you want to run really fast with your fingers in your ears screaming “LA LA LA I CAN’T FA LA LA HEAR YOU” – that’s how Christmas music makes me feel. 

I know I’ll probably lose some friends over this one. So, I guess if you can’t relate by telling me how much you hate Christmas music you can list your favorite Christmas songs in the comments so I can tape them to gift boxes and throw darts at them….or maybe I’ll make tiny little straight-pin flags to torture my Voo Doo Santa with.


Then I Broke An Old Lady’s Zygomatic Process

….okay not really, but if I wasn’t anti-oldladypunching I would have. It’s probably a good thing I hold this stance on using my fists to show 70 year old women what I think, otherwise there’s a good chance I would have earned myself a nice new set of silver bracelets yesterday afternoon (and this blog post probably would’ve been titled very differently – ex. “How I Got Kicked Out Of Medical School”).


Anyway, let’s start at the beginning. During my 12 minute drive (that is a long drive for this town) to school yesterday I had some time to think. Naturally I was thinking, “How can I bore these gullible people who read my blog just a wee bit more today.” I decided I would write about how, when people ask what I’m doing with my life and I tell them I’m in medical school, the most common response I hear is “Oh, to be a nurse?

Now, let’s get this straight right now, I have nothing against nurses. In fact, my mom is a nurse and she’s pretty dang awesome. And my sister-in-law is a nurse and she is almost as awesome as my mom. I just think it’s….strange….that I get asked this so often. I did some very formal research asking around at school and have conclusively discovered that my male counterparts have never had this response, but many of the other females in our class hear the same question often. I guess all I really mean is that a stereotype still exists that girls are nurses and boys are doctors. I won’t get into how absolutely eff-ing ridiculous this is based on the amount of male nurses and female doctors I’ve worked with, but it’s obviously something people still believe, whether they hold that belief on a conscious or unconscious level I have no idea.

So, really this post was supposed to be to brag on how cool I thought it was that the last three people who asked what I’m in school for have responded with “Oh, to be a doctor?” before wondering about any other medical profession.

But, then I put on my new jacket I purchased from the Ob/Gyn club’s fundraiser and went to the home improvement store (don’t get me started on the irony of that) to make a return.

New Jacket                    
The lady doing my return looked straight at the logo on my snazzy new jacket (which has the name of my school on it) and said “Oh what’s your major?” but, before I even had time to explain she blurted out “Or does that jacket belong to your husband?”
Excuse me? Does it…..um….what?

-glance around for store security

consider jumping across counter and using caulking tube as weapon-

“Uhh….ummm….no….NO actually it’s mine” was all I could get out.

So, normally I can pass the “Oh, to be a nurse?” off as maybe they don’t know that ‘Medical School’ is not actually some all-inclusive term for learning about anything remotely related to health care. I can understand that, everyone doesn’t know someone in nursing school or PT school or medical school and they might not understand that they are different.

But, this one….there was no mistaking her subconscious stereotyping.

She was either saying “You look like you wear men’s clothing.” or “There’s no possible way you are actually in medical school, that MUST belong to your (apparently very tiny) husband.”