On A First Name Basis: What’s In A Name?

I like the warm-up group exercise where individuals take a few minutes to write and then share in a gathering the story of their first name. How they came to have their first name?  It’s a way to share something in a group that may not have been ever shared with others. It's an opportunity to reflect and hear stories of diversity with minimal risk. Storytelling and dialogue about self-identities, cultural/family traditions and relationships emerge for exploration and development.  My first name is the same as my grandmother’s middle name.  In my family, it was inappropriate to call adults by their first names.  Like many families with southern roots, formal salutations (e.g. Mr., Mrs., Dr.) and last (family or sir) names were used when referring even to close family friends.  It’s now more acceptable to use first names for informal settings even in the exchange between adults and children.  In school, work and beyond you learn through others and norms, how to address those in leadership roles and where formality matters.  In the profession of medicine, the Dr. title indicates creditionals, offers a distinctive meaning of respect, as well as privilege and power for allopathic and osteopathic physicians.

Nurses, pharmacists other professionals along with educators work side-by-side with physicians also have doctoral degrees.  Are they not doctors? Is the M.D., Ph.D. a doctor, doctor?  The New York Times article“When the Nurse Wants to Be Called ‘Doctor’” opened heated debate on this topic revealing the divides among physicians and other health professionals who are committed to collaborative approaches for high-quality, safe and compassionate patient care.  Advanced degrees and specialty training incresease knowledge, compensation and leadership opportunity.  Highly trained individuals charged with treating illlness, the relief of pain and suffering and wellbeing should be able to find acceptable nomenclature to define their roles and work.



In The New York Times Health blog Dr. Danielle Ofri laments the term “health care provider” as a definitivie title for her role as a physician.  The increasing influence of other fields and professions collaborating in medicine is likely to continue the need for revision. For example, new retail clinics are new employing doctors.  Imagine "Yes, we take walk-ins. Go to aisle 6 just past the toothpaste. The ________ will see you now."  The New England Journal of Medicine essay by Dr. Pamela Hartzband and Dr. Jerome Groopman describes the rise of complexity within our health system pointing to another dimension of the struggle for identity and language.  In the business world there’s a push to drop formality and consider first name exchanges to establish common ground.   You have to examine carefully the norms and policy in your setting to understand appropriate strategies in addressing those around you.  Furthermore, pay attention to what others indicate as preference and/or ask directly for the sake of clarity and to avoid offense. You should also make known your own personal and professional preferences known to others.

Do you use formality when addressing attendings, mentors and informality with colleagues?  What’s your take on all this name calling?  Have you ever been called out for inappropriately addressing someone?

Chat for heart health with storytelling

Chat for heart health

Dr. Tom Frieden, Director for the Centers for Disease Control and Prevention led a #CDCChat about cardiovascular disease and stroke. Here are a few of the tweets:

.@katellington Risk increases as you get older but healthy habits start in childhood. Never too soon or too late to be healthier.#CDCchat

— Dr. Tom Frieden (@DrFriedenCDC) December 13, 2011

.@TheHeartTruth As Nieca Goldberg writes, men and women have different hearts. Heart disease and stroke kill more women than men. #CDCchat

— Dr. Tom Frieden (@DrFriedenCDC) December 13, 2011

Heart attack signs differ 4 women. Shortness of breath, fatigue, abdominal pressure, nausea, heartburn, jaw/neck/back/shoulder pain #CDCchat

— Sister to Sister (@sisterhearts) December 13, 2011

Is there a link between hypertension (HTN), CVD, stroke and health?@MillionHeartsUS @CDCgov@DrFriedenCDC @MillionHeartsUS#CDCchat

— Katherine Ellington (@katellington) December 13, 2011

.@katellington Yes, hypertension is a leading reversible cause of heart disease and stroke. #CDCchat

— Million Hearts (@MillionHeartsUS) December 13, 2011

You can walk and talk for better health.Schedule a walking meeting. #CDCchat

— Katherine Ellington (@katellington) December 13, 2011

"The Art of the Walking Meeting" by @tedeytan bit.ly/s5xIIJ #CDCChat

— Katherine Ellington (@katellington) December 13, 2011

@katellington @arielleslam @fastfwdhealth thanks for continuing the #WalkWhileWorking revolution! Tweet me with your results :)

— Ted Eytan, MD (@tedeytan) December 13, 2011

What is the single best thing we can do for our health? Amazing answer via @docmikeevans youtu.be/aUaInS6HIGo

— Katherine Ellington (@katellington) December 15, 2011

Visible Hope: World AIDS Day

My first experiences with HIV/AIDS came through personal encounters with relatives and friends who were diagnosed. More experiences came while I was volunteering in a community hospital Emergency Department where there were a few patient cases to learn about the opportunistic infections, treatment and survival. I also came to know more about the isolation, stigma, shame and emotional pain further complicating HIV/AIDS.

While working with projects in South Africa where people were shedding apartheid for reconciliation’s embrace there was also the emergence of HIV/AIDS.  I remember times of powerful sharing and connection with women in communities of faith as well as in other settings. I listened to their stories.

A few years later. My very first academic writing accepted for publication was a narrative analysis of HIV/AIDS and Women motivated by a course in community health. In this chapter, I examined individual behaviors, political will and social inequalities contributing to HIV/AIDS risk among women in the United States, Caribbean, South East Asia and sub-Saharan Africa. Through reading, research and writing I came to understand more about biological, socioeconomic and political pathogens in fight against in HIV/AIDS.

In this fight leadership has made all the difference.  From the United States to Uganda and throughout the world the global health community offers models for moving collaborative action in the fight against illness and disease.

The One and RED campaigns collaborate for the ONE & (RED)’s World AIDS Day event and the End of AIDS report show evidence of progress, on-going commitment and hope for the future.  PEPFAR is working toward an AIDS free generation. The Foundation for AIDS Research (AMFAR) is focused on “getting to zero” with the NIH Center for AIDS research advancing science and medicine for new promising approaches in treatments and prevention including vaccine development. Treatment as prevention holds promise in reducing HIV transmission with antiretroviral treatment furthering the push to have everyone get tested, a challenge for primary care and public health.  

We can all finds ways to work for the end of HIV/AIDS by employing our resources (time, expertise and/or donations) whether in your work, family, community or the world. 

You should also tell your personal and/or professional story about HIV/AIDS the statistics indicate that the pandemic has touched most of our lives as patient, health professional, caregiver, family, friend or supporter. Current global and national statistics support the understanding that most us of have been touched by the HIV/AIDS pandemic, yet many remain silent. I’ve listened to doctors and nurses offer meaningful tellings of their encounters with HIV/AIDS from needle sticks to palliative care experiences.

Final note, Sheryl Lee Ralph’s “Sometimes I Cry” offers creativity in HIV/AIDS advocacy and Dr. Sharon Allison Ottey’s book All I Ever Did Was Love A Man is a compelling story for reading groups and/or community discussion on HIV/AIDS.  Here’s a shortlist of other works to consider:

• Ashe, Arthur and Rampersad, Arnold. Days of Grace: A Memoir. New York: Random House, 1994. 
• Bayer, Ronald. & Oppenheimer, Gerald M. 2000 AIDS Doctors: Voices from the  Epidemic: An Oral History. New York:  Oxford Univerisity Press, 2000. 
• Corea, Gena. The Story of Women and AIDS: The Invisible Epidemic. New York: HarperPerennial, 1993. 
• Klass, Perri. "Hers; Mothers With AIDS: A Love Story". New York Times. 1990. 
• Verghese, Abraham. My Own Country.  New York: Vintage, 1994. 
• Young, Audrey. What Patients Taught Me: A Medical Student's Journey. Seattle: Sasquatch, 2007.

Reference

Ellington, Katherine. ‘Invisible Hope: HIV/AIDS and Women’ in ed. Grace Bantebya-Kyomuhendo. Women’s Health: African and Global Perspectives. Kampala: Women and Gender Studies, Makerere University, 2005.

From my twitter stream today:

You are welcome to leave your comments and stories, here.

A Broad Focus for Community: Occupy Health

Personal pursuits make a difference for health. Individuals who take responsible steps whether it’s more physical activity, smoking cessation or medical adherence face complex environmental challenges where place matters. Some face forces more formidable than will power. The research provides evidence to shed light on influences for health. A recent study published in the New England Journal of Medicine demonstrates how place matters.[1] These results show better health outcomes for those who have an opportunity to relocate to better living conditions. A move out of high level poverty areas improves the potential for health. Access to healthy food, safe spaces for play and adequate living conditions works in the fight against childhood obesity and diabetes compelling the need to broaden our focus in designing community-level interventions. There are many factors that influence health, the Commission for a Healthier America offers a view:

Influence on Health: Broadening the Focus

Influence on Health: Broadening the Focus

"Behaviors, as well as receipt of medical care, are shaped by living and working conditions,

which in turn are shaped by economic and social opportunities and resources" [2]

Consider another striking example: the climb of out of poverty, educational achievement and economic prosperity doesn’t change the high risk of preterm births and maternal death for black women. Dr. Michael Lu an obstetrician and gynecologist believes "that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions impacting women’s health not just when they become pregnant but from childhood, adolescence and into adulthood.” The video clip is telling as is the entire documentary series “Unnatural Causes.” [3]

There are social determinants of health. We should address issues beyond the doctor’s office that impact health. Where we live, work and play influences health, medical care and health care, our environment influences our personal efforts to achieve health. [4] Our national foreclosure crisis is making people sick, physically and mentally.[5] Yes, financial ruin is about personal responsibility. However, these situations are also tied to increasing rates of unemployment and economic downturn.  It’s like thinking about how your personal spending impacts the nation’s economy without considering the roles of financial institutions and corporations.  You make the mortgage payment every month, but the equity in your house diminishes. You go to work every day, but the same paycheck buys less of everything including healthy groceries so you grab fast, cheap food. Exercise routines may compromised when you have to work a second job to meet the bills. The stress of daily living over time may become chronic stress and put your health at risk.

The low hanging fruit to address personal behaviors may heal some, but doesn’t remedy the pervasive ills facing our society. My colleagues in community development, public health and health professions are dreamers, change agents, builders, innovators, leaders and champions for health and healthier living this makes me hopeful and willing to work for progress and the future.

References

1. Ludwig J, Sanbonmatsu L, et al. Neighborhoods, obesity, and diabetes–a randomized social experiment. N Engl J Med. 2011 Oct 20;365(16):1509-19. 
2. Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco. 
3. Courtesy of UNNATURAL CAUSES: Is Inequality Making Us Sick? Produced by California Newsreel with Vital Pictures. Presented by the National Minority Consortia. www.unnaturalcauses.org; www.newsreel.org
4. Robert Wood Johnson Foundation Vulnerable Populations brief A New Way to Talk about the Social Determinants of Health.  July 2010
5. Robert Wood Johnson Foundation, Human Capital brief ”Foreclosure Process Takes Toll on Physical, Mental Health.” October 2011

N.B.  This post was prompted in response to Dr. Jen Gunter's blog #OccupyHealthcare post and furthers my comments.

Community Immunity: Flu

In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry.  On a Sunday morning in late November (during the CDC's National Influenza Vaccine Week) nearly 100 African-Americans received their flu shots, we also held informational talks to dispel myths and fears, made time for physician-led Q&A and served healthy refreshments throughout the day, anyone was welcome to attend. A few doctors and nurses also received their flu shots to demonstrate leadership. We carried the message, “Flu shots are for the people you love. And for you. Flu shots save lives” with health alerts, announcements and relevant educational materials. Our success led to more expansive efforts.

A few years later when my community became the epicenter of the 2009 pandemic influenza A (H1N1) outbreak, I understood more clearly the significance of our unique efforts toward community immunity and health. In our neighborhood, there are many intergenerational families making vaccination important to protect those most vulnerable, the young and the elderly who often live in the same household. The outbreak began in nearby high school. The intensity of our local health department, leaders and communities working together is noteworthy. The outbreak took its natural, rapid and widespread course, but did not cause severe illness among those confirmed with 2009 H1N1 influenza or with influenza-like illness. While there were sharp increases in Emergency Department visits as well as overwhelming public concern local health care providers were able to manage the outbreak. 

Seasonal influenza and H1N1 are different viruses -- the 2011Influenza Vaccine includes protection against H1N1 along other influenza strains.  It seems that every neighborhood in New York City now has multiple options to a receive flu shot and the public health messages abound locally and nationally because it's important.

As a physician-in-training, I've learned valuable lessons from this experience about public health.

N.B. This post also appears on the RWJF Public Health blog in the "Share Your Public Health Story." 

References:
 
Wake E, Geevarughese A, Zucker JR. Influenza prevention and control, 2010-2011. City Health Information. 2010;29(6):49-56.
Lessler J, Reich NG, Cummings DA, et al. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med 2009;361:2628-2636

Food and health

Those who garden teach us how to work at the future.

A recent gift from a friend's garden.

I’m from a family of southerners who in moving to the city did not abandon their roots. I grew up with a small garden of tomatoes, peppers, and greens in the backyard, which cannot compare to the vast produce of warmer, well-cultivated countryside farms. Family and friends making visits to Georgia and South Carolina would return with tasty varieties of sweet potatoes, collards and other delights including my favorite chow chow, a vegetable relish of green tomatoes, cabbage, peppers and spices.  Chow chow is a condiment that works well with greens and/or beans.  I grew up loving vegetables on my plate with few exceptions. I’m getting back to these dishes including updates for favorite recipes see “the goodness of kale” at the end of this post.  I also support food grown within reach from backyards to local farms.

Food provides the nutritional value that we need to be healthy.  A great meal often involves tasty food, good company and time to share.  Food Day provides an opportunity for reflection to change the way we eat and think about food. The grave health statistics for our nation include rising rates of childhood obesity, diabetes and cardiovascular disease all have some remedy with improving the access and availability of food so that healthier choices become easier (and tastier) choices.

National and local activities are taking place to build awareness and mobilize.  We should be encouraged with opportunities to “eatreal” supporting healthy, affordable food with a real focus on local availability. Food Day principles for changes in food and health include:

1.     Reduce diet-related disease by promoting safe, healthy foods.

2.     Support sustainable farms & limit subsidies to big agribusiness

3.     Expand access to food & alleviate hunger

4.     Protect the environment and animals by reforming factory farms

5.     Promote health by curbing junk-food marketing to kids

6.     Support fair conditions for food and farm workers

There are many national and local events taking place, today. Learn more about Food Day at www.foodday.org.

The goodness of kale


Kale is a hearty leafy green loaded with vitamins and minerals. Kale is good food for you and tasty too.  Here are a few of my recipe suggestions:

It takes about 2 lbs of cut (remove some of large stems) for 4 servings.  Wash greens thoroughly in cold water. 

Garlic and kale greens

Add 5 cloves of garlic to 2 tablespoons of olive oil in a large skillet. Heat on medium begin to add greens once garlic starts to cook.  Add ½ cup of chicken stock, 1 teaspoon of hot pepper flakes and cover tightly.  Let simmer for about 20 minutes.  As greens wilt toss them a few times.  Optional:  Serve with warm corn bread. Add slices of cooked chicken-apple sausage or kielbasa.

Kale and white bean soup

Follow directions above and add an additional cup of chicken stock, one 16 oz. can of white beans and 1 cup of fresh sliced mushrooms.  Let simmer for about 20-30 minutes in total.

Kale chips

Preheat oven to 350 degrees F. Spread cut and washed (pat dry) kale on a cookie sheet. Sprinkle lightly with coarse sale and drizzle with olive.  Let cook 15-20 minutes until crisp. Serve warm or cold.  Great crunchy snack or add flavor to a salad.

Olive oil in these recipes adds flavor and also aids digestive absorption of the many vitamins and minerals found in kale.  There are lots of varieties of kale to choose from, curly green are most abundant.   These dishes will take you through the winter as the frost and chill actually improves the taste of the dark green earthy goodness found in kale.

The Center for Science in the Public Interest is a non-profit watchdog and consumer advocacy group convening Food Day, a nationwide campaign with individual and organizational sponsors.

Occupy Health

The occupy movement has reached more than 1,000 cities in the U.S and around the world. In her provocative blog post “What Think Tanks Owe the People in the Park,” Janice Nittoli asserts:

“It's never been the task of the people in the park to come up with the ideas.  It's their job to call attention to injustice, to demand that the powerful be held accountable, to just plain get angry at massive inequity.  It's the job of others to articulate an action plan for thinking progressives - and not just by repeating the same ideas that we had five, ten or even 15 years ago.”  

High rates of unemployment, foreclosure crises, homelessness, looming national concern about the economy, children living in poverty, educational gaps leaving too many left behind is moving young people to the street, too. The sick and the aging are living longer lives with fears and realities of financial ruin more grim than the end of life. While health professionals and institutions are facing burnout and closing doors. 

"Foreclosure is not just a metaphorical epidemic, but a bona fide public health crisis. When breadwinners become ill, they miss work, lose their jobs, face daunting medical bills — and have trouble making mortgage payments as a result." 
                                                                            —Pollack and Lynch, New York Times op-ed

Health is more than the absence of disease or cure. Health is about well-being and the quality of our lives. “Doctors for the 99% has become the name for an informal group of health activists who have set out to support the occupation.” A recent post by Dr. Matt Anderson offers a moving multimedia story about #occupy health professionals and organizations.

Last Saturday night, my commute was interrupted. The subway system rerouted trains, I had to get off and leave the station at Occupy Times Square (aka 42nd Street) to reconnect at another station located a few blocks away to reach my final destination. My short walk in the dazzle of Broadway’s flickering lights and bustling crowds included a brief occupy encounter, an experience that stirs my hope.

The twitter hashtag #OccupyHealth offers context to consider medicine, health, and health care. We should be inspired to imagine new possibilities for such a time as this. Huge drifts in differences have not always been offered with civility. Rising injustices leading a spirit of inequity should push us to listen, think, engage and act accordingly. 

Making House Calls: A Story for Primary Care

A community doctor allowed me the privilege of bearing witness to his private practice by providing a training ground for early lessons in the practice and art of medicine. 

Hypertension, diabetes, glaucoma, diverticulitis, gout, cardiovascular disease, lung and breast cancers were among the most frequent of memorable cases that I recall from months that I spent one day a week observing patient care and providing administrative support — a premedical student’s dream. Office hours began in the afternoons and continued late into the evenings with overwhelming demand peaking during the winter months when cold and flu were on the rise. The office was open late because most of the patients worked full-time, but were often underemployed and/or underinsured and needed evening hour appointments. The small waiting area was always crowded, but most endured the wait with resolve because they respected for his commitment to care.  Patients knew that he would take the time to listen when it was there time.  This came through when they called for appointments and checked-in at the desk.

Patients usually lived within a five mile radius of the office, which was on the lower level of the doctor’s modest home, a few blocks away from my grandparents’ house.  He was their neighbor and physician, too. There were significant numbers of couples and intergenerational families in this patient population. I’d learn that most had been patients for many years. There was also an increasing number of new patients, who were always offered appointments near the end of office hours to accommodate more time as were the patients with complicated situations.

When illness loomed beyond his reach, the doctor helped his patients navigate a world of specialists and the hospital experience by managing expectations, explaining procedures and calming their fears while acknowledging the uncertainty. He held regard for and equipped caregivers, too.

A few times a week, the doctor made house calls to a few select patients with urgent care needs. I remember when he visited my grandmother when she had too much leg pain to get out of bed. He diagnosed her sciatica, gave instructions about rest, wrote a prescription and a note for work. Many years later he’d return to our home to see my grandfather for respiratory distress, the house call focused on helping our family come to terms with the pressing need for his hospitalization as well as to come to grips with the gravity of his condition. 

Physician house calls give a glimpse of the patient’s environment, lifestyle and dynamics that can go untold during history-taking. A vegetable garden growing on the side of the house may confirm some commitment to nutrition. Indoor odors with a hint of bleach may offer notes on cleanliness.  On the other hand, the smell of alcohol or tobacco may match symptoms visible in the chart. House calls offer a glimpse of the patient en vivo informing diagnosis, treatment and decision-making.

In this primary care practice setting, I gained a profound sense of the trust and respect necessary in the relationship between doctor and patient as well as the connection between community and doctor. 

I learned others lessons that I look forward to sharing in forthcoming posts.

N.B. Doctors providing primary care services deliver “definitive care to the undifferentiated patient at the point of first contact and [taking] continuing responsibility for providing the patient's care...Primary care physicians devote the majority of their practice to providing primary care services to a defined population of patients. The style of primary care practice is such that the personal primary care physician serves as the entry point for substantially all of the patient's medical and health care needs - not limited by problem origin, organ system, or diagnosis. Primary care physicians are advocates for the patient in coordinating the use of the entire health care system to benefit the patient.”

—American Academy of Family Physicians

In Memoria: Do Justice

Last month, my beloved great Aunt passed away after battling illness with the same kind of  spirit she took on to address the challenges in her life applying tenacity, courage and a good sense of humor.  I had the honor and privilege of writing her obituary. It was a time of healing, reflection and contemplation. Memories, pictures and inquiries with family and friends helped me move through a century of American history to offer a vibrant narrative on her struggle and strength in living out a meaningful life.   

Remarkably, my Aunt was a leader in our family and community.  She was a critical thinker, agitator, strategist and organizer who kept a close view of the world and hand in our lives encouraging resiliency, progress and love.  

As a young woman, she and my maternal family escaped the threat of harm by moving from a small South Carolina town on the boarder of Georgia to New York City.  During the 1940s many black families were making the same travel plans because Jim Crow left many realizing that flight was a better response to their fears than a fight because so much blood had already been spilled. I believe as her eulogist suggested that untold horrific stories of her encounters with discrimination and racism moved my Aunt to work after work and family responsibilities in the civil rights movement. She taught me lessons about what it means “walk humbly, love mercy and do justice” in a world that doesn’t seem to favor the empowerment of people of color. In her eyes doing justice involved working actively in the community and beyond for the sake of humanity.

While the legislation of the Civil Rights Act of 1964 outlawed discrimination against blacks and women, including racial segregation there was still work to be done for progress.  For example, prior to 1964 it was illegal for people of color to go to a hospital to receive medical care anywhere in the United States, very few places had colored hospitals. Many organizations continue the push for justice in education, employment, housing, health care as well take on the criminal justice system for the well-being of our society.  Since 1909, the National Association of Colored People (NAACP) has been pivotal in leading the way by addressing injustice. Today, the aim is to bring an end to the death penalty in the United States, you can join this cause at http://action.naacp.org/EndTheDP

“When in Gregg v. Georgia the Supreme Court gave its seal of approval to capital punishment, this endorsement was premised on the promise that capital punishment would be administered with fairness and justice. Instead, the promise has become a cruel and empty mockery. If not remedied, the scandalous state of our present system of capital punishment will cast a pall of shame over our society for years to come. We cannot let it continue.”

           
          —United States Supreme Court Justice Thurgood Marshall, 1990

I’ve come to understand professionally that lethal injections are not good medicine.  According to the Innocence Project, “seventeen people have been proven innocent and exonerated by DNA testing in the United States after serving time on death row.” I agree with the National Urban League statement “disparities and problems cast a long shadow of doubt over our criminal justice system.”

The state of Georgia shamefully executed Troy Davis on September 21, 2011 despite serious doubts about his guilt. But our fight to abolish the death penalty lives on.”

                                                               —Amnesty International

In fifteen minutes, execution by lethal injection ended the life of Troy Davis with too much doubt. 

 

Lethal Injections Are Not Good Medicine

Recently, two executions by lethal injections were carried out in America. One ended the life of Troy Davis in Georgia, the other with too much hate Lawrence Russell Brewer in Texas. Death and dying offer complexity and complications in the profession medicine bound by policies, mandates and laws driven by internal (e.g. professional associations, medical boards) and external (e.g. federal, state, medical center) forces.


Lethal injections involve delivering a fatal dose of drugs resulting in unconsciousness, paralysis, cardiac arrest then within minutes, death.  Dr. Marc Siegel’s recent commentary on “Doctors and Death Penalty Cases” notes that “… physicians helped design the lethal injection protocol. We provide the intravenous access, monitor the patients, administer the injections, and declare death. — That’s not at all what I thought I was signing up for when I enrolled in medical school.”

Bioethics helps us question our beliefs and values as they unfold in the treatment and care of patients. We should consider, first do no harm.

Since 1980 the American Medical Association code of Medical Ethics has opined against physician participation in capital punishment including lethal injections. As of 2010 the American Board of Anesthesiologists (ABA) will revoke the certification of members who participate in execution by lethal injection. ABA board member, Dr. Mark Rockoff makes a salient remark, “if lethal injections are medicalized, it could make it look like operating rooms are like death chambers, that anesthesiology drugs are death drugs and anesthesiologists are executioners. That would all undermine public confidence in the medical profession.”  These decisions are not based on the appropriateness of the death penalty.

Overwhelming schedules, research demands and high volume patient case loads should not push us away from this challenging dialogue and/or opportunity for advocacy. The debate here is personal, political and inter-professional one that should not be avoided by health care professionals.

This post also appears at www.KevinMD.com

I've joined NAACP #toomuchdoubt campaign, Amnesty International and others in the move to end the death penalty in the United States and around the world.

A common cold

If you are from North America a most frequent health concern is the common cold. It turns out that most of us will suffer from the common cold or upper respiratory related-illness, but recover quickly. You can take sensible measures to help us avoid infection. I'm from a family with deep southern roots and a tradition where my grandmother had hand in my early childhood upbringing. Her sense of health and well-being includes home remedies, she believes in the power of chicken soup to help the healing process.
 
Here's a note to prevention post for self-care:


• Practice healthy habits.
• Eat a balanced diet.
• Get enough sleep.
• Exercise.
• Do your best to keep stress in check.
• Wash your hands.

Home remedies abound including talk about andrographs, echinecea, vitamin C, zinc lozenges. What do you suggest for the common cold or flu?  

References:

Ackerman, J. Ah-Choo! The Uncommon Life of Your Common Cold. New York:  Hachette Book Group, 2010

Are you prepared for disaster? My notes on storm survival

If you’ve seen the news recently, you know that emergencies can happen unexpectedly in communities just like yours, to people like you. We’ve seen tornado outbreaks, river floods and flash floods, historic earthquakes, tsunamis, and even water main breaks and power outages in U.S. cities affecting millions of people for days at a time and now Hurricane Irene is coming. Health care professionals need to be prepared for unexpected weather and emergencies.

I was never concerned about weather patterns beyond the four seasons of the New York City atmosphere. It’s worth noting that my grandmother was born just off the Savannah River in the night of a storm, she's lived in New York for over 75 years, but continues to pay close attention when joint pain and a distinct stiffness combine with an inner sense telling her body that a storm is coming soon. I remember her strict commands that all electrical appliances should be shut off and no one should talk on the phone. We’d sit quietly and still, far away from windows with shutters closed. When the clap of loud thunderstorms came, she’d say "hush now God's talking" eventually there would be storytelling about dark nights, lightening strikes, flooding, other disasters and lives lost in the her South Carolina homeland. We’d also listen to radio reports.

The changing temperatures and severity of recent natural disasters around the world now have me following weather patterns and my storytelling prompt is the memory of Hurricane Ivan. My reflective essay is published in The New Physician magazine conveys early reflections on the traumatic experience of Ivan. While many years have passed, a residue of emotions and feelings still surface under the right conditions. The sudden approach of certain hues of grey in the sky, the hint of a sweet smell of moisture in the air, winds whistling gently stirring trees refresh my memory. It was a warm, clear, blue sky day filled with sunshine when the forecast of Hurricane Ivan was announced. In the early hours looking at the dopplers on CNN, we thought the storm might pass despite technological and sensory intelligence to the contrary. Within moments, the daylight disappeared, darkness emerged and the power failed soon thereafter. The results:

“Catastrophic damage to Grenada and heavy damage to Jamaica, Grand Cayman, and the western tip of Cuba. After peaking in strength, the hurricane moved north-northwest across the Gulf of Mexico to strike Gulf Shores, Alabama as a strong Category 3 storm, causing significant damage. Ivan dropped heavy rains on the Southeastern United States as it progressed northeast and east through the eastern United States, becoming an extratropical cyclone.”

Ear-popping pressure systems created by the wind should not be under-estimated, you can be blown away, physically. The effect of continual downpours with rising tides can trigger a real threat to life when water is everywhere. Storm surges, high winds, tornadoes, and flooding are the hallmarks of hurricane hazards.

Are you prepared for disaster? “ Preparing for the Unexpected” is the course that I taught for the American Red Cross course, I continue to serve on a volunteer medical reserve corps and have Advanced Disaster Life Support certification. National Preparedness Month is in September, here's a foretaste using the resources and tools provided.

"Individuals and families are the most important members of the nation's emergency management team.” Craig Fugate, FEMA Administrator 

Here are my notes on family disaster plans:

• Discuss the type of hazards that could affect your family. Know your home's vulnerability to storm surge, flooding and wind.
• Locate a safe room or the safest areas in your home for each hurricane hazard. In certain circumstances the safest areas may not be your home but within your community.
• Determine escape routes from your home and places to meet. These should be measured in tens of miles rather than hundreds of miles.
• Have an out-of-state friend as a family contact, so all your family members have a single point of contact.
• Make a plan now for what to do with your pets if you need to evacuate.
• Post emergency telephone numbers by your phones and make sure your children know how and when to call 911.
• Check your insurance coverage - flood damage is not usually covered by homeowners insurance.
• Stock non-perishable emergency supplies and a Disaster Supply Kit.
• Use a NOAA weather radio. Remember to replace its battery every 6 months, as you do with your smoke detectors.
• Take First Aid, CPR and disaster preparedness classes.

Visit http://www.ready.gov for additional details follow these three steps.

1. Get a Kit: Keep enough emergency supplies on hand for you and those in your care – water, non-perishable food, first aid, prescriptions, flashlight, battery-powered radio – for a checklist of supplies visit Ready.gov.

2. Make a Plan: Discuss, agree on, and document an emergency plan with those in your care. Work together with neighbors, colleagues and others to build community resilience.

3. Be Informed: Free information is available to assist you from federal, state, local, tribal, and territorial resources. You can find preparedness information by: Accessing Ready.gov to learn what to do before, during, and after an emergency.

Police, fire and rescue may not always be able to reach you quickly, such as if trees and power lines are down or if they're overwhelmed by demand from an emergency. The most important step you can take in helping your local responders is being able to take care of yourself and those in your care; the more people who are prepared, the quicker the community will recover.

On the Rise: Women in Leadership

We are living a new era where the progress for the civil rights of women is undeniable, yet Facebook COO Sheryl Sandberg points out in her compelling TED presentation:

“We still live in a world where some women don’t have [civil rights]. But all that aside, we still have … a real problem … women are not making it to the top of any profession anywhere in the world.

The fault line is in the family and life balancing act women must do to survive in the workplace.  To be clear this is true for men too. Women are more likely to face challenges when long work hours, travel and the business of professional networking keep them away from families.

Furthermore, the profession of medicine requires a commitment to patient care, education and research, but the climb to the top has additional milestones. While many put in extra time and sweat their persistence still places them outside the closed doors of  hospital board rooms, department chair offers, academic medicine positions or physician-leader roles.  Data and research are scant on measures for progress.  I always look at the pictures on the walls in medical center hallways and conference rooms, it’s rare to see anyone who resembles me in those pictures. I do see women moving through up the ranks who are awesome role models.

For the last 10 years medical school classes have held equal portions of men and women, but those who teach medical students and lead institutions are predominately men.  Recent research published by Dr. Borges and others indicate that “women physicians choose their careers because of the perceived quality of life, earnings potential, and organizational reward. They are less likely than men to identify role models for professional–personal balance.”

Women do need to seek out role models early in their careers, but it’s not enough. More significant is the understanding that if there’s no institutional, top-down approach to addressing the complexity of these issues, meritocracy alone will not break down barriers nor will change occur.

Dr. Karen Sibert’s recent op-ed in the New York Times inspires my blog post along with other offline discussions, including the talk with Michele Martin on NPR’s Tell Me More, which aimed to further the conversation about part-time career choices women are making in the face of doctor shortages, decreasing health care budgets and a moral obligation. Dr. Sibert and others make it clear about the sacrifices for both men and women when it comes with a commitment to patient care, but Dr. Au and others make the case for our right to choose, wisely and carefully.

I follow the career paths by reading the literature as well as over the years books written by women in medicine, here are just a few from my bookshelf:

Treatment Kind and Fair: Letters to a Young Doctor by Perri Klass

Zenzele: A Letter for My Daughter by J. Nozipo Maraire

Final Exam: A Surgeon’s  Reflections on Mortality by Pauline Chen

Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Katrina S. Firlik

Medicine in Translation: Journeys with My Patients by Danielle Ofri

Almost Home: Stories of Hope and the Human Spirit in the Neonatal ICU by Christine Gleason

The Country Doctor Revisited: A Twenty-First Century Reader edited by Therese Zink

Stories of Illness and Healing: Women Write Their Bodies edited by Marsha Hurst and Sayantani DasGupta

On a historical note Dr. Virginia Apgar’s story is endearing as she was set on becoming a surgeon, but gender discrimination led her to a career in anesthesiology after training she went on to head a new division of anesthesiology where she developed the Apgar score. As the medical school’s first female division head, she built a residency program and, in 1949, became the first woman appointed to a full professorship at the Columbia University College of Physician & Surgeons.  No, I’m not interested in a career anesthesiology, I am looking for opportunities where innovative ideas are supported regardless of gender, race or ethnicity.

A few pointers, I’ve heard from those listed above and elsewhere:

• Relationships and family matter, try to avoid undermining your anchors to move ahead, you may find short-term success and long-term misery with the loss of your family and friends and a more demanding job.
• Don’t turn your head or look way when you see real harm done to women especially if it’s you in the hot seat, choose battles worth fighting.
• Read and review the policy handbook at your institution. Knowledge is power.
• Honor and respect women physician-leaders in their roles and get to know their stories.
• Tell your own stories so that others might know of your success and/or be warned of your pitfalls.
• “Lift as you climb” so that you enable collective success in the profession.
• The road is long so make good friends for the distance.

U.S. Surgeon General Regina Benjamin, Secretary of Health and Human Services, Gov. Kathleen Sebelius and First Lady Michelle Obama are at the helm efforts to improve health and health care in America and these women are all phenomenal. We should continue our look up stream and push for policies and practices that allow for a more balanced profession for men and women, which in my view enables better patient care and improves quality of life for both patient and physician. There should debate, divergent points of view as well as common ground to stay focused on more progress.

7/12/2011 blog cross-post on KevinMD.com