Tag Archives: Ally

“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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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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Happy birthday, ADA

Today is the twentieth anniversary of the Americans with Disabilities Act! *blows party horn*

I didn’t know that earlier today. But, I did a little personal ally work in support of accommodation, so I am proud of myself.

The student who is sharing the surgery rotation with me is disabled. She was in a terrible car accident about five years ago, and shattered her ankle and heel. She has some difficulties walking and standing for long periods of time. She has been very successful when assisting on alternating surgeries, but she has asked our attending if she can sit when it’s my turn to scrub in at assist. My attending is fine with her sitting, but occasionally, the OR staff gives her a hard time.

Today, a nurse anesthetist started making really sarcastic comments to her when she sat before the procedure started. “Do you want me to get you a pipe and a smoking jacket?” he sniped. He turned to the one of the other people in the room and said “Is that what it was like when you were in medical school?” He made a few more rude comments. My classmate just glared at him from behind her mask, and didn’t say anything. She feels really put on the spot when those sorts of things happen, and doesn’t choose to make excuses.

After the procedure was mostly over, the surgeon took my classmate to go to pathology to check to see if the sentinel lymph nodes that were removed were negative, and the assistant and I remained to close the mastectomy. Once the incision was closed, and we knew the nodes were negative, I told the whole OR team that was assembled that I had something to say.

“I heard someone saying something to (classmate) earlier about her sitting down. I wanted to let you know that she is disabled. She was in a really bad car accident and her ankle was shattered. She has trouble standing for long periods of time. She has asked to be able to sit in the OR if she is not assisting, and Dr. (Attending) has told her it’s OK. She’s really self-conscious about it, and won’t say anything to anyone who asks her about it. I just thought it was important for you all to know.”

There were some mumbles and grumbles, but no other comments. There were two anesthetists and one anesthetist student there when the comments were made in the beginning of the procedure, and they all kind of look the same with their caps and masks on. One of the anesthetists left before the procedure. I am not sure if the one who made the comments heard what I said, but I hope his buddies go back and tell him what I said if he was the one who left. I wasn’t necessarily trying to teach him a lesson in particular, but I wanted to let everyone on the staff to know that people may sit because they need a disability accommodation, since this isn’t the first time someone has given her a hard time.

Maybe the next time someone sits down, they won’t automatically assume they are being lazy.

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Nothing like bad news to drive a message home

(Trigger warning for poor obstetrical outcome)

Less than one week after I blogged about the maternal mortality crisis among black women in our country, I lost a friend. She was of Haitian descent, a fellow medical student, an aspiring ob/gyn, and a kind and wonderful person. She was eight months pregnant with her first baby, and newly married. We talked for a while last week about her taking time off, breastfeeding, and pumping when she got back to rotations. She was incredibly happy about becoming a mother.

She went into premature labor this weekend. She had a hemorrhagic stroke. She died. The baby is doing fine.

This was not an underprivileged woman by most definitions, at least not currently. She may have been raised in an impoverished home. The Haitian population in South Florida in general is devastatingly poor. She was well educated. She was not “advanced maternal age”. She was not a teen mother. She was not obese. She had good prenatal care and insurance. She had family support and was happy about her pregnancy. As far as I know, she had no health conditions, didn’t smoke, and didn’t do any drugs.

But, she was a black woman in America, which puts her at much higher risk of premature labor and death. In recent years, the maternal mortality rate for black women in Miami has been up to 10 times that of white women. We don’t completely understand why. Different delivery of care, early life malnutrition or lack of health care, the stress of racism, biological or genetic differences…these all may play a role.

But, right now what we do know is that a baby is born without a mother, and a husband is welcoming a new baby in his life with a dead wife, and no mother to help raise it. That is a horrible shame.

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Proud to be an American

Happy birthday, USA!

When I say I am proud to be an American, (a USian, really, but I am quoting a song title), I am proud of what we have done that is progressive, such as women’s suffrage, and the civil rights movement. I am also optimistic of the potential we have to improve ourselves. I do not think that means we have to ignore problems that we have, or not admit mistakes, as many people mistakenly consider patriotism to be. I think having low standards and ignoring our issues is the opposite of patriotism.

Anyway, despite the partially successful civil rights movement of the 60′s, there is still glaring racism and racial inequalities in our country. Please check out this blog carnival at the Uneccesarean. It’s a round up of posts discussing the shockingly and depressingly high rates of infant and maternal mortality suffered by black women and infants in our country.

And, before someone goes there (which has happened before on this blog and on others so often it’s on racism bingo cards), it’s not a class issue. These inequalities still exist even when the mother is college educated, compared to white mothers who don’t even have a high school degree. This is more pervasive and deeper than class. Not that poverty isn’t important, but there is no quota for issues we should address to make this country even greater.

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Excellent article on female sexual dysfunction

Please go check out part one of a series on female sexual dysfunction on K’s Feminists with FSD site. Like me, stay tuned for part 2. This post covers the history of statistics on female (and male) sexual dysfunction, as defined and discussed in a landmark article in JAMA, Sexual Dysfunction in the United States.

One of the good points she makes is:

According to Sexual Dysfunction in America, there are seven symptoms of sexual dysfunction. Keep in mind though, the authors did not factor in the degree of symptom severity, and did not factor in how individuals felt about their sexual problems. (Some people have difficulty maintaining an erection or researching orgasm, and are comfortable with that.)

Go read the whole thing!

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