Monthly Archives: September 2010

“Doulas” is now a MeSH term

I am a proud research nerd, which involves being a PubMed nerd. PubMed tries to organize its articles by keywords called MeSH terms. Well, they just added the term “doulas”!

Doulas received an “A” evidence rating from the US Preventative Services Task Force and a favorable Cochrane database review. But, if you go to the Cochrane Database and enter in the keyword “doula” into their search, you come up with zero results. Its doula review is labelled “continuous labor support”. Let’s hope the addition of “doulas” as a MeSH term normalizes its use.

Also, other Mesh terms were added, including:

Airway Management; Bleaching Agents; Bullying; Carbon footprint; Catheters; Counterfeit drugs; Drug-Seeking Behavior; Epigenomics; Exsanguination; Examination Tables; Food, Organic; Gestational Sac; Hair Bleaching Agents; Gynecological Examination; Lost to Follow-Up; Nasal Sprays; Pets; Recyling; Sex Reassignment Procedures; Sex Reassignment Surgery; Social Stigma; Watchful Waiting; Wireless Technology.

Thanks, Rachel, for the blog post about the new MeSH terms, and the rabble rousing to get the MeSH term added. (Ha, I just noticed I am mentioned in the original post she wrote on this topic.)

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Resources in Spanish for patients

The Agency for Health Care Research and Quality (a group of which I am a fan) has released Spanish language guides for patients. I am happy about this for a few reasons. Selfishly, I need to learn more Spanish, especially medical Spanish. I am hoping I can read over these guides and learn how to discuss these conditions more effectively. Of course, that doesn’t help me when a patient asks me a question outside my very limited scope of Spanish proficiency. But, it’s a start.

I was also happy because I thought these guides could be a good resource for the attending physicians at my rotation site. For example, one is A guide to breast biopsies (PDF) (non PDF versions are available at the first link). I just finished a surgery rotation with a team of surgeons who do a lot of breast biopsies, many of which are on women who only speak Spanish. However, it’s 12 pages long. I think it may be nice to put a copy out in the waiting room instead of a magazine, but it is too long to pass out to all the patients.

The are also a few guides specific to pregnancy:
Induction of labor
Gestational Diabetes

I haven’t read them, and my understanding of Spanish isn’t great, so I may not be able to offer a decent critique of their quality. However, this quote from the induction of labor guide troubled me:

Las investigaciones no determinan si la probabilidad de que una mujer tenga una cesárea es diferente si ella elije la inducción en lugar de esperar a que el parto comience espontáneamente.

Unless I am mistaken, it says studies have not determined whether the probability of having a cesarean is higher if one has an induction, rather than a spontaneous labor. That has been researched, and the ACOG Practice Bulletin #107 states that there is a twofold risk of cesarean in a nulliparous (first time birthing) patient than one who has a spontaneous delivery. Also, the chance of vaginal delivery with induction is strongly association with the patient’s Bishop’s score. A Bishop score is easy for a health care practitioner to determine in an office visit, and is not that difficult to explain, at least in general terms, to a pregnant person. I am disappointed in how few people who are induced even know what the Bishop score is, or what theirs was. Of course, if it is a medically indicated induction, it will most likely be attempted even with a low Bishop’s score. But, it is an elective induction, and the pregnancy is only 39 weeks gestation, and the Bishop’s score is low, especially in a nulliparous mom, an induction is very likely to be protracted, and end in a cesarean.

(Hat tip Women’s Health News, Catching Up Edition, which, ironically, I was catching up on)

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Today

Today is my younger son’s sixth birthday. He is such a sweet, funny, earnest kid. Yesterday night he told me that he didn’t want to turn six. “I am going to miss being five. Don’t you miss being five? Having fun?”

Yes, yes, I do, Z.

I have been putting off wrapping his presents. I am about to finally tackle that. After I write a blog post about not much, and whatever other stalling techniques I come up with. I got him a bunch of little things. We are going out to eat tonight, and we’re having a small birthday party on Sunday.

I helped out a cardiology fellow at my rotation site with some sympathy and advice about the course of his wife’s pregnancy recently. I was so happy to hear today that the fetus appears to be “small but extremely healthy” according to the maternal fetal medicine specialist they went to go see. He told me that I should consider an MFM fellowship. An intern whose service I am on happened to listen to our conversation, and was blown away by my obstetrics knowledge (I think he is easily impressed, really, I didn’t even say anything that complicated) and said “You’re an ob/gyn already!!” That was nice to hear. I don’t know. I am definitely attracted to MFM, and would love to spend the majority of my time with obstetric patients. I am just so old. I will be 40 my first year of residency. An MFM fellowship is another three years.

And, to wrap up a post of non sequiturs, I figure I’ll list the songs I sang along with today as they came on the radio, just because they tickled me in their diversity.

Hey Jude – The Beatles
Crazy Game – The Indigo Girls
Rebel Without a Pause – Public Enemy
Tainted Love – Soft Cell
Keep Your Hands to Yourself – Georgia Satellites
She’s Crafty – The Beastie Boys
Holiday – Green Day

I am rubbing off on my kids. S, my older son, asked to hear Don’t Stop Believing by Journey and The Lady Is a Tramp, Lena Horne’s version, the other night while in the kitchen with me. Last night he asked me to turn up Ani diFranco’s Little Plastic Castles and said “This song is awesome.” I quite agree.

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Best psych quote ever

So, I am more than halfway done with my psychiatry rotation. I find psychiatry a fascinating specialty. Maybe it can be a back up plan if I can’t match in obstetrics. (Argh, Maude forbid).

We have had our share of patients with schizophrenia in the facility throughout the month. Some are highly functional, most of the time, but since we are an acute inpatient care center, most of our patients are not very functional. One, when discussing his job prospects, said “You need to get me in touch with NASA. I want to play football for them. The pornographic kind.”

Oh, wow. I have images of this huge guy playing naked zero gravity space football seared on my brain now. Nice.

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I’ll tell you what I regret, and what conclusions I am jumping to

*Trigger warnings for discussions of sexual assault*

I don’t want to go into a lot of details about this, because I don’t want to violate HIPAA or trash any of my peers or future peers specifically. Suffice to say, I find it very disappointing that people in the medical community, including people who should really know better, don’t realize that someone who is severely intoxicated cannot consent to sex. It’s not “next day regret”, and I am not “jumping to conclusions” for following that theory. It’s sexual assault. End of story.

We are supposed to be advocates for our patients. It’s bad enough that people in the community don’t understand that rape isn’t just some scary dude jumping out of the bushes and clubbing some demurely dressed virgin over the head, and dragging her off to violently violate her. When physicians and future physicians dismiss (or worse, joke about!) sexual assault on intoxicated individuals, or even worse than that, discourage a peer from following that line of questioning with a patient because it would be “jumping to conclusions” because “we weren’t there and we can’t say if she consented”, it absolutely infuriates me. Especially if such a person has a history and physical strongly suggesting that this is a likely scenario.

OK, rant over.

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Excellent blog post on the BS that is abortion parental notification laws *link fixed*

I have always been against parental notification laws because it seems like the teenagers that would have the problems with notifying their parents probably have a good reason, and a good relationship with your parents cannot be mandated by some law. It seemed to be these kids who don’t have good parental support would be the least likely to be able to navigate the legal system, and probably have the least social and familial support necessary to be a successful parent, especially a teen parent.

Also, it seemed ironic that a minor is no longer considered a minor and can make medical decisions for herself once she becomes a parent, and supposedly can be trusted to make decisions for an entire new life – her baby, if she decides to continue the pregnancy and gives birth, but she can’t be trusted to make one single medical decision for herself to not continue the pregnancy. And finally, I was worried about abusive parents or parents that would throw a minor out of the house for becoming pregnant.

At a Medical Student for Choice conference, all of the abortion providers on a panel said it was much more common to see parents come in and try to coerce their minor daughters to terminate, and the daughters to be resistant, than the other way around. Of course, they refused to do terminations under those circumstances.

Well, Harriet at Fugitivus has an awesome post up about what the reality is like for teenagers trying to get judicial bypasses. She describes the many situations she sees, from a missing in action dad, to abusive parents, to dead parents, to illegal immigrant parents, to rape victims, etc. Here is an excerpt from the section on abuse victims:

She may know she’s from an abusive family. She may not. She may simply be used to not talking about it, because it’s so shameful. She may not know there’s anything to talk about, assumes that everybody lives this way.

She will not disclose to us, and she has not disclosed to the clinic, because we are complete strangers. The clinic doesn’t have access to her medical records, which could possibly help them discover the history of abuse. The clinic is not her usual doctor, or usual clinic. This girl does not disclose because abortions are performed as something separate and segregated from other routine medical care, and at a time during which this girl may have the guts to tell somebody what is happening to her, she is surrounded by complete strangers, and called a whore and a murderer whenever she tries to access those strangers.

Please read the entire post. It is wonderfully written, as all of her posts are, and it is chilling and moving. But, most of all, it is rooted in practicality and reality. I think a lot of social conservatives want to wag their fingers and think that is all it takes to make other people live the way they think they should ideally live, based on their own particular lofty standards, and then wash their hands of the consequences of what happens when real people don’t meet those standards. I prefer to live and reality, and would like to make reality work better for the most people. Parental notification laws are the opposite of that.

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What I learned on my surgery rotation

I just finished with my two months of surgery rotations. I am starting a month of psychiatry today. I am looking forward to it.

I am happy to say that I really enjoyed my surgery rotations. I thought I was going to be intimidated by the OR, but I found it fascinating. I am relieved, since surgery is a big part of ob/gyn.

Here are a few thing I learned on my surgery rotation:

Scrub in before the surgeon but after the OR nurse.

Before you scrub in, introduce yourself to the OR staff and give them your glove size.

The OR is really cold. At our location, they keep warmed blankets in a room right off the OR. Great for the patients, and great if you are observing to procedure. Can’t use them if you’re scrubbed in, of course.

You can use the suction to suck the smoke coming off the Bovey (electrocautering tool).

Getting the gown on and tied is the hardest part of the scrubbing in procedure.

When you cut surgical knots, pronate! Pronate! (OK, that was just with my surgeon. Every one has their own particularities).

If a nurse offers you a standing stool, say yes. But then don’t trip over it.

Don’t say “whoa!” really loudly with surprise if a blood vessel starts spurting into the air. If you can help it.

Ask if you can close, don’t wait for them to offer.

Ethicon has free knot tying practice boards, available on their website.

Urine output is important. Bowel movements are important. You will have to notice and talk about both, a lot, especially post op.

Hmmm, I can’t think of anything else, but I’ll add more if I think of more. Wish me luck in psych!

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