Monthly Archives: January 2011

Notes from pediatrics outpatient clinic

I am just finishing up a great month on peds outpatient. Here are some notes / lessons learned / comments to parents:

(Please note that I am a parent and usually am pretty resistant to judging parents)

1. “Sexy” is not an appropriate nickname for your three year old daughter.

2. Please try to remember to turn off your phones, parents. Answering and saying “Yeah, hey, I’m at the doctor with the kid, bro, let me call you back” while I am examining your child is, to say the least, distracting. That’s what the vibrate mode / voicemail is for.

3. If your kid is coming in for an asthma exacerbation, and currently has an asthma inhaler at home, trying to use the inhaler before coming in and then actually remembering what the name of it is when you come in (hey, even bringing it in!) is a great idea. I love the parents who bring in the bottles of meds.

4. It is amazing how wide the range can be of what worries parents. There are parents who will bring in a kid for one day of clear runny nose, no fever, no sore throat. There are parents who will fight with you about going to the hospital when their kid seems to have something clearly wrong that needs further workup that can’t be handled adequately in an outpatient setting.

5. I was happy and amazed how cute the kids were to me. Even the cranky ones. Even the ones who cried at the site of my white coat.

6. Parents, please don’t use the vaccines as a threat of punishment for bad behavior. And, please don’t use them as some sort of sick joke to scare your kids and get a laugh as I am coming at them with the stethoscope.

OK, as of Tuesday, I am swinging to the opposite end of the cycle of life. On to Geriatrics. Wish me luck!


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Trust Women! (For more than a month even)

Trust Women I am so excited! I just bought a Trust Women silver pin for my white coat! I opted to donate to the organizations listed, including one I belong to and one of my personal favorites, Medical Students For Choice. I can’t wait to wear it!


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Back to twitter

I have decided to go back to Twitter. But, I can’t remember my password, apparently, and the email account I had when I signed up for Twitter was cancelled by my lovely ex, so I can’t get the password sent to me.

So, I started a new Twitter account as @momstinfoilhat. I am not promising lots of pithy material. I wasn’t all that prolific as @MomTFH. But, I wanted to be able to tweet occasionally, and follow people again, so, I signed back up.

Please feel free to follow me, or make suggestions on feed I should follow.

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Blog for Choice Day 2011

Well, I almost missed it, but I am squeaking in with a Blog for Choice Day post at literally the last minutes of the day.

This is the 38th anniversary of Roe v. Wade. In order to commemorate this, NARAL has asked:

Given the anti-choice gains in the states and Congress, are you concerned about choice in 2011?

Yes, I am concerned, but not just because of the recent elections. Midterm elections tend to go against the party who holds the presidency. This one was no exception. But, what does have me concerned is the incessant drumbeat of anti-choice legislation. And now, HR 3 of this session in the House of Representatives is called No Taxpayer Funding for Abortion Act. Even though directives voted in by the same legislative body on Thursday said they want to overhaul the health care reform proposal to “lower health care premiums through increased competition and choice” and “greater flexibility”, this competition, choice and flexibility does not include what the majority of private plans cover. It does not include the most common surgical procedure in the United States. It does not include what is the medical choice of 30% of the women in our country at some point in their reproductive lives.

It’s not just the Tea Partiers who were elected who are responsible for this. The Stupak-Pitts amendment already made abortion coverage illegal in the new law unless the mother is “in danger of death”, or the pregnancy was due to rape or incest. If private insurance plans covered abortion, the amendment made sure none of the subsidies could go toward this coverage. Private insurance companies were told they had to get a separate check from customers, or cut the coverage from their plans.

And, after this victory, the anti-choice lobby still thinks that HR 3 needs to address this?

Yup. I’m concerned. I am concerned that controlling woman’s bodies is such an important political football that it keeps stealing center stage. There is no interest in preventing unplanned pregnancies. New proposed spending cuts would hack hundreds of millions of dollars from Title X funding for contraception. There are also more anti-choice suggestions afoot – proposals that there needs to be insurances in the exchanges that don’t offer contraception (labelled as more “virtuous” choices – what??) and legislation pending that would keep organizations like Planned Parenthood that provide contraception and abortions from getting any government associated reimbursement for any non-abortion activity, like providing contraception.

This is not an effort to decrease abortion. I am concerned that such blatant anti-choice, anti-woman activities can be floated as reasonable, and that the pro-choice politicians seem to think this is a difficult political argument to win.

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Infuriating…voting on a grad student’s pregnancy?

Isis the Scientist recently wrote about a seriously stupefying incident that occurred at UC Davis Veterinary School. One of the 85% female class had a baby, and the class presidents wrote a letter to the entire class asking them to vote on how to grade her and deal with her maternity leave, or lack thereof.

…Below are listed the options that Dr. Feldman has suggested. Please reserve comment on these options and provide us your opinion on them by voting when the time comes. Thank you for your understanding in this matter.

a) automatic A final grade
b) automatic B final grade
c) automatic C final grade
d) graded the same as everyone else: best 6 quiz scores out of a possible 7 quiz scores (each quiz only given only once in class with no repeats)
e) just take a % of quiz scores (for example: your classmate takes 4 quizzes, averages 9/10 points = 90% = A)
f) give that student a single final exam at the end of the quarter (however this option is only available to this one student, all others are graded on the best 6 quiz scores and the % that results)

I am happy to say a groundswell of WTF *facepalm* reaction from her readers and hopefully members of the class and greater UC Davis community has engendered (pun intended) a response from the chancellor of the school, Linda P.B. Katehi:

…I want to assure you that I take very seriously any allegations that a student’s welfare, dignity or academic rights have in any way been compromised. And as a woman, who has experienced firsthand the challenges of melding academic and family life and has experienced discrimination, I am especially sensitive to this issue. This alleged action, if found to be true, would present a serious deviation from the values and principles that guide our campus and our School of Veterinary Medicine, and I would be profoundly disappointed if the reported events did in fact transpire on this campus.

I have asked Ralph Hexter, UC Davis’ provost and executive vice chancellor, to initiate a thorough review of this matter. He will ensure that all appropriate procedures are followed and that the appropriate campus authorities will make a final determination as to whether any campus policies and procedures were violated and, if so, what steps need to be taken. I expect rapid attention and response from the provost.

Our veterinary school, with an enrollment that is 85 percent female, has a long history of providing accommodations for the health and well being of its students and their families. During a student’s pregnancy, the school customarily works with her to help catch up after being away for childbirth or to arrange for an extended leave after which she can resume her academic program. And for mothers of infants, the school provides a lactation room so that students can continue breastfeeding their babies.

Right on, Chancellor.

I find it extremely hard to believe this is the first time this has come up. Every year in medical school there has been a few students that have had babies. It is not a generous leave policy at our school. You either have weeks or a year. If you are on rotations, you can arrange to take a month off. I know many students who feel pressured to schedule their births, either by cesarean or induction, in order to make it fit in with their rotation schedule or class schedule.

I am looking forward to being in residency with younger women. I am done with the baby making. I will be happy to step up when they need maternity leave, and will be the first to defend them.


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Defensive medicine series

Please hop on over to The Unnecesarean for an outstanding series on Defending Ourselves Against Defensive Medicine. I am sorry to say I was invited to contribute and didn’t manage to get a piece ready. I am very impressed with what has been released so far.

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When is a person old enough to refuse treatment?

(Trigger warning for discussion of coercive medical care, rape analogy)

I am loving my outpatient pediatrics rotation. Really loving it. Even when they are snotty, crying, and uncooperative. I love it. I am a little scared of how much I love it. I don’t think I would waver from ob/gyn but…it’s tempting, I’m not going to lie.

One thing that would make it difficult for me to be a pediatrician is the difficult concept of informed consent to care, and autonomy of the patient, when it involves a pediatric patient. (I am really into informed consent and right of refusal even for practitioners.) It can be complicated enough when we’re talking about adults who are patients. With minors, it’s even more complicated.

I know that pediatrics is in its own even grayer area, since many children, especially very young ones, would refuse all sorts of diagnostic tests and care if it was up to them. Most kids don’t want vaccines. Or blood draws. There are plenty of kids who scream and cry if you want to look in their ears. Pediatrics would look a lot different if children were allowed to refuse.

There are cases where older children have refused care such as blood transfusions.

I saw a case recently that troubled me. My cousin Susan’s young daughter had symptoms of a urinary tract infection. (Details have been changed to protect privacy, as usual.) She had a fever and some sort of hesitancy or pain with urination that was hard for her to express because of her age. She also has a history of acute pyelonephritis with sepsis which required hospitalization, which is a pretty seriously complicated urinary tract infection (UTI). She was unable or unwilling to provide a urine sample. So, the practitioner decided to do a urinary catheterization so obtain a urine sample.

(Trigger warning here) It was a disturbing scene. It took two people to hold the screaming girl down, force open her legs, and the catheterization involved forcing an object into a structure in her vagina. She was whimpering and holding her vagina for a while after the procedure.

Sigh. I am not a medical professional yet. I fully understand why the medical practitioner wanted a urine sample to screen for bacteriuria. This practice is quite conscientious about not prescribing antibiotics when they aren’t necessary. Considering her history, she was definitely at risk for a complicated UTI. Waiting could have led to scarring of her kidneys, among other possible issues. Should she have been treated empirically? All of the antibiotics they could choose have side effects. A good clean catch from a catheter is ideal for a culture and sensitivity, for appropriate treatment. What if it was something else? Should they have sent her home with a urine collection bag taped to her? I don’t know. As I said, complicated. I was just disturbed by the fact she was offered a lollipop afterwards, as she sniffled and held her vagina. What kind of a message is this sending to this little girl? Does this, in some big picture way, contribute to acceptance of sexual assault, either by her in the future or by the witnesses?

Ugh. I am absolutely not questioning the ethics or the judgment of the practitioner in this case. It was obvious to me why she chose to catheterize the child. I am just saying I find it troubling, although justifiable.


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