Things That Work ~ by Jay

Sometimes I'm appalled at how dependent I am on my technology. When my cellphone can't access my calendar, I can't get find the addresses for my home visits. When my computer freezes, I can't write my visit notes (or send in my billing). When my Bluetooth headset keeps disconnecting, I can't safely use the phone when I'm driving. I no longer have a paper address book - everything's in my Contacts. Which reminds me, I should back up the computer tonight.

The last few weeks I've been increasingly aware of that dependence, since my phone wasn't working well. Some days it couldn't hold on to the Bluetooth signal from the headset. Some days it couldn't find the cellphone signal. Lately it can't find WiFi about half the time, which makes it much harder to use the calendar. It's a small thing, but it's like having sand in my shoe - it rubs constantly and slows me down.

There's a voice in my head that says I should be able to do fine without a cellphone at all, and I certainly shouldn't need WiFi and Bluetooth. Entitled spoiled brat, the voice whispers. The voice wasn't swayed by the ways in which my job requires me to use a cellphone. The voice didn't care about the fact that this was my third version of this phone; the company replaced it twice because of other hardware problems. You're not eligible for an upgrade, said the voice. You have to wait. I could have spent another four or five hours trying to solve the problem with software updates, phone calls to tech support, and a trip to the service counter. Tonight I decided that I valued my time and my peace of mind enough to tell the voice to go hang. Turned out when I got to the store that I am already eligible for an upgrade, so the voice was not only sanctimonious and self-righteous, it was wrong. So there.

I am deeply grateful for the material privilege that allowed me to do this, and, again, amazed at how much happier I am when I have the tools I need. I think I've balanced my work and my life well, and that balance is resting on top of a pile of technology. As long as the power stays on, I'm good.

National Coming Out Day ~ by Jay

Today is National Coming Out Day. I am a straight ally. I want to work to create a world in which no one needs to come out, because no one needs to be closeted - a world in which children and the adults they become are accepted, loved and celebrated for who they are and are free to love, in turn, the people who are right for them.

I donated my Facebook status via HRC's Facebook app, but didn't put my name on the WE COME OUT announcement in my college's paper. I'm not comfortable equating saying that I'm coming out just because I identify myself as a straight ally. I have finally learned that when someone comes out, it's not about me.

The wording of the college announcement also seemed to me to exhort closeted GLBTQI folks to come out, as if it is their obligation to do so in order to fight injustice. I will not tell anyone they should come out. When I speak out as a straight ally, I may lose a relationship with someone who disagrees with me. When my friends come out as gay or bisexual or transgender, they are literally risking their lives. They may be ridiculed, ostracized, bullied, harrassed, assaulted, or killed. They can be fired with impunity in many states. Their kids could be taken away. Who am I to say they have to take those risks? It's my job to push the rest of straight society to reduce that risk. We need to use our straight privilege to fight injustice. We need to tear down the walls of the closet - and until we do, we need to respect those who stay in the closet for their own protection.

Arwyn addressed this issue in a recent post about how allies often let our righteous outrage get in our way. I'm sure I've been the hapless speaker in both of her scenarios, and not that long ago. Now I hope I can be a better listener when my marginalized friends talk to me, and save my outrage for the conversations with others who hold privilege, which also means we hold the power to create change.

"It is not your obligation to complete the task,
but neither are you at liberty to desist from it entirely..."
Pirke Avot 2:16

Football Takes On Violence Against Women ~ by Jay

I wish I were talking about the NFL. Ben Roethlisberger is playing this weekend after serving a four-game suspension. he was accused of rape - for the third time. He was originally suspended for six games, but it was reduced to four on appeal. Three accusations of rape, and he sat out four games.

I wish I could imagine anyone connected with the NFL making a video like this one, from Australia:



It's not perfect. I know Australian footballers have their own issues with sexual assault. I'm also not entirely thrilled with the video. I don't like the "what if it were your mother/daughter/sister?" meme at all. Women's safety matters because women are people, and not only because they have men who care about them.

On the other hand, it's a really good start. The video talks about emotional as well as physical violence. The message is clearly aimed at boys and men, and the footballers recognize that it is their responsibility as men to change their behavior in order to end violence against women.

I'd love to see something like it from the NFL, but I'm not holding my breath.

Quote For The Day ~by Jay

Forgiveness is not the misguided act of condoning irresponsible, hurtful behavior. Nor is it a superficial turning of the other cheek that leaves us feeling victimized and martyred. Rather it is the finishing of old business that allows us to experience the present, free of contamination from the past.

-Joan Borysenko

Blogging Anonymously ~ by Tigermom

So this week Mothers in Medicine is hosting a Metablogging week. What is that? It is blogging about the experience of blogging. Navel gazing for sure, but stuff that hits me to the core.

I write infrequently here, though I comment freely on my favorite blogs, because of my conflicted feelings about blogging.

I love to read blogs. I enjoy practicing writing out my thoughts. I live for Fizzy's cartoons, the things people say to Dr. Grumpy, and The Happy Hospitalist's analyses about healthcare.

But I worry about being judged. I worry about my own privacy. I worry about my patients' privacy.

I learned about blogs when Mama told me she had started one and I started to read hers. A curious first read escalated quickly into nightly reading sessions while sitting with Cub #2 at bedtime. When Mama and Jay started this blog, I wondered if I would ever feel brave enough to do similarly.

Reading blogs lets me into the worlds of so many people. And it is that privilege of listening to peoples' stories that appeals to me in my work as a psychiatrist.

But I would rather disappear than tell my own deepest darkest secrets.

While I think it is therapeutic and thought provoking to let it all out, I fear being judged more.

So, I could blog instead about everyday things, not deep dark secrets: the vagaries of parenting, work/family life issues, medical practice issues?

I feel too busy parenting to write much about that.

I feel more or less in balance with my work and family, ie never quite in the right balance.

I cannot see any way to write about my patients and still respect their privacy.

And Dinah, Clink, and Roy at Shrink Rap channel everything I think about how to practice psychiatry already even when they disagree.

My first post was inspired by a real event that moved me. As was my second or third. Being moved seems the right motivation to write. So maybe I have a high threshold for being moved. I shared my blogging with Tigerdad, my sister - who is a real writer, and my mom - my eternal support. And they all have been supportive.

But I struggle with privacy.

Psychiatrists grove on conflict so feel free to interpret, but gently please.

Booze and Babies, Redux ~ by Jay

Yeah, I'm wading into this again.

The Journal of Epidemiology and Community Health recently published the results of a prospective study investigating the impact of various levels of alcohol consumption during pregnancy. This is the best evidence we have yet, and it confirms previous research. They performed cognitive testing on five-year-olds, and found that two drinks a week during pregnancy does not correlate with any cognitive decline.

I suspect that women who drink more heavily than that during pregnancy have other problems as well. I'm not saying that women should drink during pregnancy. It's clear, however, that the tsk-tsk-tsk, don't touch that glass, approach we've been taking is not supported by the evidence, and it ignores a host of other issues that put women and their children at risk.

Bluemilk said it best in her comment on my last post on this subject:

If only strangers felt the same readiness to intervene on behalf of an in utero baby when its mother is being beaten (ie. the frequency of domestic violence is much higher for pregnant women than for non-pregnant women), going without enough food, or being forced to live in highly polluted neighborhoods.

Alas, drive-by concern for a baby's health is not so eagerly pursued when it does not also involve controlling women's bodies.

We should use the power of the government to put decent grocery stores in poor neighborhoods and reduce the levels of heavy-metal contamination in the soil. In the US, we should also make sure pregnant women have access to decent prenatal care. We should address prenatal education as a collaborative process, not an opportunity to shame women and express our racism and classism.

If we really cared about children (and their mothers) we'd be doing a lot more to address the societal issues that put them at risk. What we're doing now is abdicating that responsibility and trying to control individual behavior instead. That's precisely backwards.

Things I Could Do Without, Survey Edition ~ by Jay

I like to be a good scientific citizen, so when a professional organization sends me a link to a brief research survey, I click on over and do my duty.

Today I was asked to opine about whether I discontinue certain medications (like the cholesterol-lowering medicines called statins) in patients when they are referred to hospice or palliative care. I was not happy about the way the two disciplines were lumped together. Patients who are not yet on hospice usually want to continue active treatment of their disease; for patients with a history of heart attack, statins are active treatment. Hospice goals of care are different and do not include active treatment of disease. Hmm. Not sure about this research group. On the other hand, it was a 20-item survey; what would it hurt me to answer? Onward.

And downward. 10 questions about scenarios in which I "routinely" discontinue "some or all medications" at the time of referral, or continue them until "the patient can no longer swallow". The scenarios varied by disease process, life expectancy and history of heart attack, but the answers were the same, and for every one I checked "other" and filled in the text box. After the second I started pasting the same answer in every box. I do not discontinue or continue medications "routinely", or in any other unilateral fashion. I discuss options with the patient and family and they make choices based on their priorities and values. I offer them the option of stopping, but it's not my decision.

I was clicking along, rolling my eyes, until I reached question 15:

How often do you discuss your decision with the patient?

A) Always
B) Frequently
C) Sometimes
D) Never

I stopped rolling my eyes and starting muttering under my breath. Seriously? Are there people out there who stop medications and don't discuss that with the patient? Are you kidding me? Who has to swallow the damned things? Who has to suffer the side effects? Who, in the end, has to pay for them? Not the doctor.

We're supposed to be the specialists who listen to our patients, who take values and opinions into account. We work collaboratively with nurses, but we're not supposed to use them as shields to protect us from conversation with out patients. No, I don't think statins have any significant benefit for patients who elect hospice care (and I'm conservative and skeptical about their use in primary prevention). Some of my patients are relieved to learn they can give them up. Some of my patients think statins are life-sustaining, and they are terrified to stop taking them. My job is to take both beliefs seriously. No decision is "routine" if it's your life that's being decided. My patients have autonomy. I am the coach on the sidelines; they're actually playing the game.