I gave a lecture for the combined didactics of our graduate medical education program and the one at our affiliated hospital. It was a bit of a shock to be asked this early, and it was on a topic for which I didn’t have a prewritten lecture already tucked away. But, it was on breastfeeding, so it was fun to put together. There’s so much good information available out there from the AAFP, WHO, AAP and ACOG.
I was surprised how many of the male residents came up and told me they enjoyed the lecture! Maybe I’m being sexist? One of the male family practice / neuromuscular medicine residents came up and said he’s a midwife at heart and wanted to give me a hug!
Anyway, I’m pooped. Here’s the presentation. (Oh! And I GOT MY OWN DOPPLER!)
WordPress won’t let me embed Prezis anymore, so here’s the link: my breastfeeding presentation.
My recent post on mandatory reporting of intimate partner abuse being possibly more of an emotional response for the caregiver rather than good care for the victim has been republished at KevinMD:
Should every case of domestic abuse be reported?
Go check it out. There are some great comments there, as there were here.
I have my USMLE Step II CK on Saturday, and my COMLEX Step II CK August 1st. So, sorry I haven’t had time or mental functionality to blog much. I have tons of stuff I have wanted to share. Let’s see if my medical fact clogged brain can remember a few of them.
NPR has been rockin’ lately. First, I heard Morocca say “hula doula” on Wait Wait, Don’t Tell Me” recently. They have been running a really great series on birth called “Beginnings: Pregnancy, Childbirth and Beyond”. It included a great piece on elective inductions that provoked a lot of comments when I shared it on my Facebook page.
NPR’s Facebook feed also tipped me off to a new report by the Institute of Medicine, “Clinical Preventative Medicine for Women: Closing the Gaps” which recommends mandating insurance coverage of contraception,” since it is preventative medicine. To quote Rachel from Women’s Health News, “Duh!”.
In addition to copay-free coverage of birth control, the Institute recommended:
screening for gestational diabetes:
*human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30
*counseling on sexually transmitted infections
*counseling and screening for HIV
*lactation counseling and equipment to promote breast-feeding
*screening and counseling to detect and prevent interpersonal and domestic violence
*yearly well-woman preventive care visits to obtain recommended preventive services
Anyway, I should be studying. Wish me luck.
I have been thinking lately about practice patterns and interventions lately. I went for my annual female exam recently, and was chastised by the family medicine resident because I haven’t had a mammogram yet. Gizabeth wrote about a similar discussion with her physician at Mothers in Medicine. She opted to get the mammogram. I argued with the resident. I left with a prescription to get breast ultrasound, which I am unlikely to fill.
I have seen doctors recommend mammograms to patients starting at 35 or 40. I have never personally seen anyone go by the USPSTF recommendations for low risk women to wait until 50.
I told the resident I was going by the USPSTF recommendations, and I thought mammography would be a poor screening tool for me and my particular set of circumstances. I breastfed for a combined three and a half years. I don’t smoke or drink excessive alcohol. I have no relatives with breast or ovarian cancer. I had my first kid in my twenties. Never used hormonal birth control. I’m white. And, my breasts are quite large. There’s not particularly fibrous, I don’t think, but that’s a lot of tissue to try to squish and see through. A lot of tissue to be repeatedly irradiated.
I am not a complete Luddite. I think mammography is an imperfect tool, but obviously saves lives. A recent study called The Swedish Two-County Study showed a life saving benefit to mammography, but according to this Time magazine article (disclosure: I haven’t read the full study yet), “In the study, women aged 40 to 49 in the screening group received a mammogram every two years; those aged 50 to 74 were screened about every three years.”
ACOG recommends ” that women in their 40s continue mammography screening every one to two years and women age 50 or older continue annual screening.”
I am not sure which group recommends screening at 35. but there probably is some medical association representing a specialty that has guidelines starting that young. For myself, I am planning on doing a baseline at 40, then probably not getting many more until I turn fifty, unless something comes up. For my patients, I will start discussing their particular risks and priorities, and we will work from there.