Monday, December 12, 2011
Guest post: Med Peds
I ended up matching in Med Peds, and realized after the first 3 months of internship when we switched specialties that I was in deep trouble. (My program, typical of many Med Peds programs, has residents switch from Medicine to Peds every 3 months and so on.) Throughout my residency, I felt like I was constantly behind all my categorical colleagues. I was also tired of having to do so many inpatient and ICU rotations. That’s what happens when you try and cram two 3 year residencies into 4 years.
When I got pregnant in my 4th year, I was forced to give up my international rotation. I was very upset, and felt that I was being punished for being a woman and pregnant. (This harkens to all the blog entries and posts about residency requirements for maternity leave, time off, etc etc.) There were too many core rotations to do, and so I couldn’t do a “fluff” rotation when I was already going to take time off for maternity leave. (I took 8 weeks off after having a C-section for a premie, and then in the midst of trying to establish breastfeeding, went back to outpatient clinic 2 half days a week 2 weeks afterwards, and also had to do a rotation that involved reading books and writing papers. After all that, I had to make up 2 weeks at the end of residency.)
In retrospect, I would have just forced myself to pick either Medicine or Peds. It was too stressful trying to do both. At heart though, I do enjoy being a Med Peds doctor. I still enjoy taking care of the whole spectrum of ages, and feel that I received excellent training despite feeling behind my categorical colleagues during residency.
The best part of it is that after practicing for a few years in a more traditional setting with lots of inpatient call, I now have a job that is 100% outpatient. I see patients Mon to Fri, and have no weekend and no overnight inpatient calls. Yes, I do have to be available 24-7 to answer telephone calls, but it’s a world of difference from having to go in to the hospital in the middle of the night. With primary care, it’s entirely possible to find a group that does purely outpatient. Additionally, you have the option of doing urgent care or being a hospitalist, and these types of options are far better in my mind than traditional outpatient plus inpatient duties. With the increasing popularity of hospitalists, both adult and peds (though peds is now just starting to catch on), there are now more and more options for practices that allow you to work more regular hours where you can actually see your kids. It will be not prestigious or lead to awards and recognition if you are looking for a purely outpatient job, but as long as you don’t aspire toward a distinguished academic reputation, then you have options.
Tuesday, December 6, 2011
Career Topic Week
You can link to prior topic week posts from the sidebar to see examples.
If you'd like to contribute a guest post for topic week, please send it as a word document to mothersinmedicine@gmail.com. Would love to have them!
Thanks, as always, for reading and being part of this community.
Thursday, December 1, 2011
Thinking big
"Someday, I'm going to turn on the TV and Dr. Thompson will be talking about something important, and I'll be like I KNOW THAT GUY!"
On one hand, I was a little insulted that nobody would say that about me. On the other hand, I agree. Dr. Thompson is smart and has ambition. While I am thinking, "How can I help my patient?" Dr. Thompson is always thinking, "How can I help this hospital? How can I help my field? How can I help the planet?" I could never think as big as he does. Mostly, I'm just trying to get through the day.
I wonder, is it because I'm a woman with kids? Does that take the fight out of me? Is it possible to be a mother of young children and also think big?
Recently, I saw a list of all the female world leaders. There are currently 20 female presidents and prime ministers, which is a record number, and half of the 10 most populous countries in the world have female leaders. These are all women (many of them mothers) who clearly think big.
It was sort of inspiring to see that list. I guess it means I have no excuse.
Wednesday, November 30, 2011
MiM Mailbag: Working abroad
There are two big issues - the first is that (aside from broken Spanish) I don't speak any other languages and the second is that my huge educational debt would prevent me from going without a salary for very long. I don't need to make as much as I would as a US employed physician, but I can't be a volunteer. I also know that medical licenses limited to one country, and most countries will not allow you to practice without licensure through their own boards (perhaps Australia and New Zealand are exceptions? I heard they are cracking down on foreign MDs due to some recent issues with substandard care).
I have a very half baked dream of working for a US embassy (perhaps doing IM) but not sure if that is really feasible or if that circumvents the issues of needing additional licensure. Locums is also an option, but have heard mixed reviews of some of the agencies. I also emailed a few agencies and never heard anything back.
I have noticed that there is quiet a bit of international readership of this blog. I would be interested to know if anyone has information regarding American physicians who would like to work abroad.
Many thanks in advance,
s
Wednesday, November 23, 2011
My Morning
--Wake up (duh)
--Shower
--Get dressed (OK, nothing remarkable yet)
--Breast pump ~20 minutes
--Pack up breast pump to take to work
--Nurse on other breast
--Change baby diaper
--Change baby clothes
--Wake up Mel
--Cajole Mel into getting dressed, sometimes doing it for her
--Make Mel breakfast
--Pour defrosted milk into pre-made bottles
--Pack up bottles with icepack + extra diapers or whatever else daycare ran out of
--More cajoling for Mel's jacket and shoes
--Get both kids into car
--Drop off Mel at kindergarten: kisses, clinging, tears
--Drop off baby at daycare: put bottles in fridge, peel off baby jacket, fill out "day sheet"
--Drive to work
Honestly, by the time I get to work, I've already been up for hours and it feels like the day must be almost over.
What's your pre-work ritual like?
Friday, November 18, 2011
Your worst sick story
Help me out. Tell me your WORST story about you or a coworker calling in sick. Like how you called in sick and then your chief resident drove to your house and beat you to a bloody pulp.
Wednesday, November 16, 2011
Sick Days, Part the Millionth
The next morning, I wake up to a furious email from the chief, saying that my text woke her up and now she (also sick) has to cover my clinic after being woken up. I was inconsiderate on not one but two counts. (Had I not woken her up, I'm sure I would have somehow been yelled at for not letting them know soon enough.)
Later that year, I get tracheitis (whatever that is). I can't talk more than a few words. I come to work, but get sent home midday by my attending. I call the new chief to tell him I'm going to stay home the next day. I don't have anything even scheduled and was just supposed to "help out" with extra consults. "Well," he says, "I can dock you for the half day you took off today and a full day tomorrow. But the problem is, you can't take off more than six weeks in a year or else you have to make it up."
"Are you serious?" I'm baffled. "This is my second sick day. Do you have me recorded as taking off more days than that?"
"I'm just warning you."
Eventually, you get the message. Never call in sick. You get trained, like a dog or a seal.
I feel like now I need somebody to tell me when it's appropriate to take a sick day. In the past, before I got "trained," I took sick days when I needed to, sometimes more readily than I should have. Now I've gone too far in the other direction. There's a balance between being responsible about your job and ignoring family/health issues. When I tell someone that my child has a fever of 102 and is throwing up, yet I'm at work, it's almost a little embarrassing. Where are my priorities?
Recently, I had a pretty serious family emergency, and although I came to work, I left early. Unfortunately, I had a meeting in the afternoon where my presence was crucial. When I talked to the attending coordinating the meeting, I explained the situation and he said he'd have to cancel the meeting.
"Oh god, I feel awful about that!" I said. "Maybe I should just go to the meeting."
The attending looked at me like I was out of my mind. "Fizzy, stop it! You're being ridiculous. We'll just reschedule."
I felt grateful but also really ashamed over the decision I almost made.
Monday, November 14, 2011
34 Weeks and Grateful, but Man, am I Dragging!
I am so, so thankful to be pregnant, and that it’s been another uneventful pregnancy (knock on wood). I am grateful for all the family help I have at home- it’s really a little village raising our son. And I am acutely aware that the warm, flexible, pro-mom, super-supportive work environment I enjoy is a rarity for doctor-moms, especially for those of us practicing primary care.
But really, I am dragging. I’m trying, but every day is a slog. This Friday was tough. Friday is my long day: 2 clinical sessions, morning and afternoon. I need to get to work early, like 7 am-ish, to get ahead on paperwork and read through the charts of the patients I will be seeing that day. Then I typically see about 16 or 17 patients, a mix of physicals, new patients and problem visits. This mixed in with the patient phone calls and emails, lab and imaging results checking, pharmacy requests, specialist and therapist phone calls…. Then I need to fight traffic. By 7 pm, when I get home to my mini “second shift”, I am asleep as soon as Babyboy is in his crib.
But I also need to make a distinction here: while I am fatigued up the wazoo, I am not burned-out.
Other practices make doctors see more patients than I see in a day. I also enjoy an unusual amount of time per patient visit- 20 minutes for problems and 40 minutes for a physical for a person over age 40. I insisted on that extra time. We also enjoy amazing nurse triage and front desk support. Many of my colleagues in primary care, especially at other hospitals, have 10 minutes for a problem visit and 20 minutes for a physical, with absolute numbers of patients seen per session much higher than what I am doing, and far less support. I don’t know how they can function.
Also, in primary care, there is the complexity of the unpredictable: you never know who is going to walk in the door, or with what. The issues can vary wildly and widely over the course of one day. Friday, I saw a distressed young lady with pelvic pain; an asthmatic who was pretty close to needing an emergency room; an unfortunate woman with a skin-picking psychosis who was infected yet again; several folks for physicals with multiple complicated medical issues such as obesity, hypertension, diabetes, all essential to address at their physical; a man with groin pain and a possible hernia; a young man with hepatitis c and depression; a lady with diabetes and pneumonia; several folks with sinus issues, but all with varying degrees of severity and comorbidities, etc , etc…
In addition to the variety, many patients and issues are not straightforward, and require reading in UpToDate (an online medical textbook) or going to the research literature, or paging a subspecialist to get a handle on what to do. Sometimes I have to send patients for x-rays or labs, and then revisit their case later in the day. Occasionally, a patient needs to be seen urgently by orthopedics for a fracture that I diagnosed, or sent to the emergency room after my evaluation, and I have to arrange those transfers. How could anyone handle a patient every ten or twenty minutes, with all of that going on? I imagine many things do not get addressed, and it must feel like a factory.
Then, always in primary care, there is the “after-work” work. The urgent labs and imaging that you and only you can really deal with. Phone calls- we are on call for ourselves 24 hours a day Monday through Friday. Fretting- wondering, Am I missing something? Am I serving this or that patient well enough? In this business, the work day doesn’t really end at the end of the work day.
This is why, at a recent lunch with a group of five female friends who trained in primary care, every single one has left or is leaving primary care for hospitalist (shift) work, research, or administration. “Burnout” was the biggest reason, as well as “better hours for family”.
So, in short, while there are plenty of reasons for me to be headed towards burnout, I am NOT. I actually enjoy seeing my patients- even with all these issues, and when I’m “massively hugely pregnant” (as one of our nurses pronounced me recently). Between my luxuriously long patient care encounters, a good support staff, a positive environment (with a great maternity leave policy, I might add), and being part-time (I work 5 clinical sessions a week), I am still liking my job! Even the long Fridays.
Still, I recognize that my emotional energy and physical stamina are not at their peak… I waddle to and fro; just getting up and performing a physical makes me short of breath; my back hurts when I sit and my feet hurt when I stand; I have near-constant reflux; I have to go pee every 20 minutes; I’m always sweaty and can’t wear a white coat for the life of me… All of these things are totally natural at this stage of pregnancy, and they also make a clinical session that much harder.
Thankfully, the vast majority of patients have been wonderfully, surprisingly supportive. I love the friendly pregnancy-themed banter at the beginning of just about every visit for everything. Even the diabetic lady with pneumonia had to (rather breathlessly) ask me all the requisite baby-queries: When am I due, what is it, do we have names picked out yet, do I have other kids, how does Babyboy feel about this impending disruption? I can answer all of these in my sleep at this point, but it’s still enjoyable when these relative strangers take such an interest in my own life.
And then, the beautiful thing-- most everyone shares a bit about their pregnancies, or kids, or nieces and nephews, or grandkids. This big belly of mine is the perfect icebreaker.
So, as tired as I am- and it’s a bone-weary, molasses-moving, heavy-duty tired- I am so glad that I am where I am, doing what I am doing, and expecting a little girl, in 6 weeks.
Monday, November 7, 2011
Rescue
Saturday, November 5, 2011
Treat Yo Self
I loved that idea and it made me realize how rarely I do treat myself, even in small ways. While I hardly live in poverty, I am rarely willing to buy myself something in any way extravagant or even a little pricey. Maybe it's my upbringing by two very money-conscious parents.
For example, I was recently at Payless (the height of shoe fashion) buying my daughter some new shoes because I could literally see her little toes sticking out of the soles of her old ones. After we tried on every size 13 children's shoes in the store, Mel picked out a pair that was acceptable. Then I remembered that I needed some boots for the upcoming winter, so I decided to check out the selection.
I found a nice pair of boots that was exactly what I wanted. They were comfortable, stylish, and boots that I could wear at work without looking unprofessional, saving me the trouble of having to change shoes at work. But the thing is, I already have two pairs of boots. One is some ultra warm gigantic snow boots that I wore in the days that I lived within walking distance of work, and the other is a pair of waterproof black boots that smell really bad inside. (Yes, I tried baking soda. They still smell.)
So the new boots were a reasonable purchase. But I had to sit there for several minutes (while my daughter pranced around in a pair of size 6 leopard pumps), trying to justify to myself buying $45 boots when I already have two pairs of boots. I reminded myself that sometimes we spend $45 on a meal. I reminded myself that Carrie Bradshaw spent $40,000 on shoes and $45 is actually pretty cheap for shoes. So I bought the boots.
Clearly, I have trouble with treating myself. I wish I could just let go sometimes and get myself something nice without feeling guilty about it.
How about you? What do you do to treat yourself?
Wednesday, October 26, 2011
Must Remember!
MUST REMEMBER:
Pay daycare. Leave check for cleaning service. Buy candle for pumpkin. Remember breastpump. Refill breastpump bags. Pack bottles of milk for morning. Need more bottle labels. Take milk out of freezer when get home so it defrosts in time. Make lunch for tomorrow. Pack and run dishwasher. Three more doses of amoxicillin for Mel. Birthday party on Sunday, must buy present. And wrapping paper. Meeting with mentee Saturday, must pick her up. Dance class for Mel on Saturday. Laundry out of control, must do a wash. Must sew Mel's costume, which is ripped from repeated pre-Halloween wearings. Help decorate for work Halloween party. Speak to someone about broken computer at work. Remember snack for Mel for drive home or else will cry. Pumpkin pie - bake or buy!
That list is running through my head all the time. And it doesn't even include the patient-related stuff. Maybe that's part of why I feel like I've been SO forgetful lately.
Yesterday was a prime example of my forgetfulness. I arrived at work and was horrified to realize I forgot my breastmilk bags, so I had nothing to pump into. I figured at this point, I should just drive to the daycare to feed her personally. When I arrived at the daycare, I discovered a note saying that I was behind on my payments. (This is not entirely my fault because they don't tell you how much you owe for the month, so I just estimate and sometimes the money runs out before the month ends.) But anyway, I realized I forgot to replace the spare checks in my wallet, so I couldn't pay them. It was an epic fail day.
Then I got out of work early and took this amazing opportunity to run to the grocery store. Two things I really needed at the grocery store were cheese and a candle for our pumpkin. After buying a bunch of things and walking out of the store, I discovered I had managed to forget both these things. Sheesh.
I'm hoping this is all a matter of having too much to remember and perhaps fatigue rather than really early Alzheimer's.
Monday, October 24, 2011
A Day at the Arkansas State Fair
Tuesday, October 18, 2011
When the G's and P's do not Align
It was 3 a.m. on a Saturday night, midway through my intern year, when the impact of pregnancy loss first slapped me in the face. As intern, I was in charge of doing the paperwork for all those being admitted to the hospital that night. The last patient on my list was a pleasant 50 year old women being admitted for pelvic pain.
In my rush to finish the paperwork and hopefully get an hour of sleep, I began hammering her with my list of questions. I started with, what every good OB/GYN intern starts with, the "G's and P’s". G=Gravida, which stands for the number of pregnancies. P=Parity, which stands for the number of deliveries. Each piece of the gynecological medical record starts with this bit of information. Yes, OB/GYNs start first by judging the ability of your womb to accept and carry a child.
“How many times have you been pregnant?” I ask hurriedly, pencil in hand.
“Only once.. but … he didn’t make it.” She said, her voice shaking, with a single tear quickly wiped from her cheek.
I was taken aback, both by her response and my own. This loss had occurred years ago, yet still stung so deeply. That night I learned to ask this question more tactfully.
A couple years later, I learned another lesson in the pain of pregnancy loss when my own joy of conceiving was quickly mired by seeing blood stained toilet paper. My loss was early, but the pain was deep and real. Time has healed my hurt, but I am frequently reminded of the pain of loss as I am often the bearer of bad news. Sadly, miscarriage is extremely common and something I had dealt with on a regular basis, but I had not truly appreciated the level of loss experienced, until I was on the other side of the stethoscope.
Over the years I learned to look differently at the G’s and P’s on the medical record. My heart will ache when I see a G6P2, realizing the painful reality that the 4 losses must represent. I cannot fathom feeling your heart sink so deep with disappointment, not just once, but 4 times.
October 15 is pregnancy and infant loss day. A time to remember and acknowledge the loss and pain that occurs when the G’s and P’s do not align. For those of you who have have experienced this loss, I cannot say I know how you feel, for everyone processes loss differently. I can say that I acknowledge that your pain is real and I pray that in your journey, you find peace and healing.
-RH+, a 36 yo G2P1011
cross posted at http://thepregnancycompanion.com/
It's a Man's Man's Man's Excuse
One of my YES moments when reading the book was when the protagonist was late for work because her nanny didn't show up on time, but she felt like she should use "a man's excuse" instead. Men aren't late because of sick kids or tardy nannies--men are late because of traffic or car trouble. And male bosses respect a man's excuse more than a woman's excuse.
Lately I've been forced to use the "sick kid" excuse a lot and I always hate it. I haven't used it as an excuse to not do work or not show up, but to explain why I'm being extremely efficient, skipping lunch, avoiding small talk, and postponing a few things till the next day. It's embarrassing for me and makes me feel unreliable. Especially when sick kid isn't miraculously better in one day and eventually requires a doctor's visit, then second kid gets sick right after. That's nearly two weeks of having to mumble excuses about sick kids.
It makes me feel like I'm seen as unreliable. It makes me feel like I'm being labeled as "that woman who's always leaving early because her kids are sick." It certainly doesn't make me feel like I'm going to get a raise or promotion any time soon.
But what else can I do?
Wednesday, October 12, 2011
My (grandmother's) legacy
My grandmother was a teacher and she loved to write. After her death, my father came across a bunch of clippings from articles she had written for her condo newsletter. If she had been around now, she totally would have been a blogger, I can tell. Her articles were all the sort of "reflections" that make up the typical blog entry.
My father told me he thought it would be a nice tribute to her to bind the articles in some way and distribute this to her relatives. I told him to let me take care of it.
Over the summer, I scanned in her articles, formatted them, and published a 100-page book on Lulu that looks exactly like a real book. Then we distributed copies of her book to all her grandchildren and other relatives.
It brought me great pleasure to do this. I know it's what she would have wanted because it's what I would have wanted. When I blog, I have this fantasy in the back of my mind that my children or even my grandchildren will someday be reading my totally brilliant insights. I was doing it for her, but in a way, I was also doing it for me. If that makes sense.
People who fancy themselves as creative types like to have a legacy of themselves in print. This book is her legacy, even if she never actually knew about it. And here's one of my legacies:
A book of my own
I think it's kind of amazing that companies like Lulu allow people like me and my grandmother to sort of live out our fantasies.