December 30, 2011

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?

December 17, 2011

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:

December 01, 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.


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:

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