MiM Mailbag: When to disclose your pregnancy at work?

Two MiM Mailbags with a similar theme...


Hi,

I am about to start Internal Medicine internship at a medium-sized county program.  I have a 2 year old son.  I had originally applied to residency when I was pregnant with him, but withdrew my application.  The Program Director of the program I matched in told me at that time "We wondered what you were going to do when you had the baby.  Glad you made the choice to take time off before starting."  Well, now I find myself pregnant again.  I am due Dec 20.  My current schedule has me scheduled for Medicine wards from Dec 13-Feb 6.  I know that I will definitely need to make a schedule change.  I am nervous to tell my Program Director.   Luckily, I am not showing yet at all (so my family and friends tell me).

Regarding childcare, my husband is taking a leave of absence from his career to care for our son and for our future child. So, While I do not really "want" a short maternity leave, I am prepared to only take off the minimum I will need.

Any thoughts or advice on how to navigate these waters?

Thanks,
S

***

Hi,

I am pregnant with twins and going to start my new job in the fall, and I am trying to decide whether to tell the hospital/group I am working with before I start which is right at the beginning of the second trimester.  Or should I tell them before they pay for my move in case they don't want me?  I think they will as it took them a long time to recruit me and recruiting has been an issue since it is somewhat rural.  And they knew I was planning on becoming pregnant at some point and were fine with that.

What would you do?

Thanks,
A

Water water everywhere...

If you haven't heard this news, Mayor Bloomberg has proposed a ban on sodas larger than 16 ounces in NYC, as a response to the obesity epidemic.

I'm not a big fan of laws designed to save us from ourselves. I appreciate the smoking bans, because I've been in restaurants where I couldn't enjoy my meal because there was smoke being blown on my face, but it doesn't keep me from enjoying a movie if the guy next to me is drinking a 20 ounce soda.

I know I've written a few posts here that make me seem like I'm some kind of champion of bad health, so I'd like to do the opposite today. I'd like to ask that instead of making laws to save us from ourselves, like no large sodas, they should make laws to help us be healthy.

For example:

A few years ago, I gave up soda. I used to drink one can of Coke every evening with dinner, and I decided I wasn't going to do that anymore. Now I mostly only drink water (or Gatorade when I get very dehydrated). I do think soft drinks are pretty unhealthy, although I mainly stopped doing it because I wanted to eliminate caffeine. Thanks to my example, my husband stopped drinking soda at home too. And my daughter drinks mostly water or milk.

On a recent road trip, we stopped at a McDonald's off the highway. I got a chicken sandwich and I wanted a water to drink. Was it actually possible to get tap water to drink in a cup? No. I had to purchase a bottle of water.

Then when I went to fill the bottle up with more water later, there was no "water" option at the soda station. I could have gotten any sugary beverage I wanted, but not water. So I went to the counter, hoping they could help me:

Me: "Can you fill this bottle up with tap water for me?"

Cashier: "No."

Me: "Really? You mean there's no way I can just get plain water?"

Cashier: "Nope, sorry."

I finally filled it up in the bathroom. Still, it's an outrage that in mall food courts and many chain restaurants (ranging from McDonald's to Chipotles), you can't just get plain water to drink. This happens to me all the time. I'm at the mall food court and I ask for a cup of water with my food, and they look at me like I'm crazy. I've been refused or I've been given a tiny cup that contained three swallows of water. Even if I offer to pay for price of the cup, sometimes they won't give it to me.

Instead of trying to save us from ourselves and banning 20 ounce drinks, I think Mayor Bloomberg et al. should make it easier for those of us who want to avoid sugary drinks to do so! Whatever else you can say about the health value of these foods, soda is certainly tons of empty calories. If you agree, urge local vendors to make water more readily available!

Guest post: Heavy heart

It's been a long day on ICU, and I'm patiently waiting for the night float resident to relieve me of my duties so I can go home, sneak into my kids bedrooms and kiss them goodnight.  Although they won't see me with their smiling faces for another 2 days.  I am a second-year family medicine resident in the southwest, and am at this point officially burned out and miss my kids terribly.  I had my second child (a girl) 8 months ago.  My son is 2 1/2.  Dad works full-time as well, but carries the brunt of the duties when I'm on challenging inpatient rotations.  "Guilty" does not go far enough in describing the perpetual feelings I harbor about leaving home every day to take care of others, when all I really want is to be taking care of my family.  Don't get me wrong, I love being a doc, and have worked years and years to achieve this goal.  But I can't help but wonder whether I will regret this all when my kids ask "Mom, did you stay at home with us?" or "Mom, who did you leave us with when you were at work?"  They are cared for by a very good friend of mine who cares for a few other kids together in her home.  She is the mother we all want and want to be for our children.  And they LOVE her.  But I can't get past the fear that they will somehow resent me being gone when they are older, and realize just how much I have been absentee.  Thus, I carry a heavy heart, nearly every day that I am away.  I've never felt like this about anything.  It's always been about me, about my goals, about my plans.  Now it's about them, and I want to give them the best of everything.  Can I still do that even when I'm away?

-Gem

MiM Mailbag: Medical school interview advice

Hi Mothers in Medicine,

I have been reading this blog for a year now, and all of your stories and triumphs (heartache too!) have inspired me to fulfill my dream of being a doctor. I was told when I was 18 that, "if you really want to be a good mother dear you shouldn't be a doctor, I've just never seen anyone be able to pull if off." So I went and did nursing school. A fabulous career, but after three years I am pretty bored and ready for something more challenging. After reading almost every single post on this blog, I've realized I can be a mother and a doctor. I also married a wonderful man who is encouraging me to pursue medicine.

The point of this post is to ask for some help to prepare for my interview. I have one in three weeks with my top medical school pick (an overseas institution, hence the summer interview).

 

Seeing as many of you (maybe many years ago) all went through the interview process I am asking for any tips, do's/dont's and general advice.

 

How did you answer that favorite question - "Why do you want to be a doctor?" other than saying, "well I want to help people"... I mean, that's why I want to do it, but doesn't everyone say that?

Warm Regards,

Amy

My Postpartum Overhaul: First Physical, and Now Mental

OK, It's a rainy Saturday. I am not on call. My husband is watching our 2 kids (under 2 years old) so I can work out. I just jumped on our Spinning bike and banged out 15 minutes of hard up-down cycling, while watching Cupcake Wars (It makes the time go really fast, and I vicariously enjoy the cupcakes, while actually burning calories!).

I thought up this post in the midst of the workout, and I jumped off the bike. Now I'm sitting here, sweaty, trying to bang out the writing. Meantime I can hear my toddler boy yelling. He's got a cold and is just  cranky, and he wants me. The baby is whimpering, and Hubby will have to make her a bottle one-handed, while our toddler howls and hurls things around the living room.

So let me be brief.

Quick backstory: I'm a part-time internist in group practice, and I had my second baby 5 months ago. My last few posts here on Mothers in Medicine have focused on my journey back to fitness after baby #2. I was 4 weeks postpartum, and realized that at 5' 2" and 163 pounds, I was officially obese. In spite of the fact that I was breastfeeding exclusively, I was gaining weight (and yes, that is common). It was my eating habits. Carbs, carbs, carbs. Bowl of Cheerios here, toast with butter and jam there.

I was shocked, but motivated. I got on the South Beach Diet and I lost a ton of weight. Listen, folks, the low-carb diets work. (I get no endorsement monies from them, BTW) (Though I would take some in a second, if they offered :)

I also started exercising again. For the first 3 months, I just ran outside when I could (though to call it running would be exaggerating. More like jog-walking) and did some Pilates on the floor before bedtime. This month I added back the gym.

And in 4 months, I have lost 30 pounds, down to 133 pounds, only 10 pounds away from my goal. I am well out of obese BMI range, and I feel great. Physically.

However, mentally, I am sagging. Now, Babygirl is still not sleeping through the night. My husband travels for work, alot. Though we have great family support, it is just a hectic schedule. My reserve is low.

But, some days, I find myself just suffering through clinic. The day will start out OK and manageable, and then, as happens not infrequently, I will encounter a difficult patient, and I will just get so down. I mean, so down that I come home and start surfing the net for non-clinical doctor jobs.

Now, the vast majority of my patients are absolutely lovely. Honestly. I have been so boosted, even blown away, by the interest people take in me and my family; by the unsolicited support for my working part-time; by thoughtful cards or baby gifts; by positive feedback on my clinical work

But just one angry/ blaming/ abusive/ demanding patient, and I am just crushed. Even when I am in the right (like in diagnosing an alcohol problem, or not prescribing narcotics). Even when I know the patient has psychological issues, and is only acting out at me because I happen to be sitting there. The negativity will get to me, even if there is no overt confrontation, or raised voices, or complaints. If a patient is unhappy, I feel like a failure. I get shaken, even to the point of physically shaking. I feel like I will have a panic attack in the office.

Colleagues are supportive. We all see many patients a week, and we all have similar experiences, day in and day out. There is plenty of camaraderie, and I can always find someone with whom to vent, and feel validated.

But, at the end of the day, I hate these negative encounters. They make me want to quit my job.

I'm trying to look into this, to see what steps I can take to build resilience so that I don't feel like I need to please everyone; so that I don't feel a failure when a patient is unhappy. I used to be much better at this.

I'm currently looking at the concept of Compassion Fatigue. This is new territory for me. What do other MiM know about this? Is this something that applies? Or am I just an exhausted new mom with little reserve in a demanding profession having a normal experience?

Study: Breastfeeding Results in Increased Morbidity and Developmental Delay

Abstract: Breastfeeding has long been touted as improving immunity and having other benefits. However, this study demonstrates that the opposite is true, and that breastfeeding results in increased infections and delayed development.

Introduction: Many studies have shown benefits of breastfeeding, but there are limitations to all these studies since the breastfeeding and non-breastfeeding groups are different. This study looks at babies of the same sex from the same parents, so obviously they're exactly the same.

Methods: Two babies, both girls, from the same parents were studied, examining the number of infections, rate of growth, and developmental milestones. Subject #1 received breastmilk for only six months and got formula supplementation during that time. After six months, Subject #1 received only formula. Subject #2 received only breastmilk for the first six months, then very minimal formula supplementation for the rest of the first year.

Results: At the end of the first year, Subject #1 was at the 99th percentile for both height and weight. She had zero ear infections and zero infections requiring antibiotics. At the end of the first year, Subject #2 was at the 5th percentile for weight and 50th percentile for height. She had been treated for two cases of conjunctivitis and three ear infections. She also threw up a bunch of times. Subject #1 crawled and pulled up two months earlier than subject #2. Subject #1 walked at 10 months of age (data on Subject #2 still pending).

Discussion: Subject #1 showed significantly decreased infection rate compared with Subject #2, in addition to improved growth and reaching milestones. Since Subject #2 received more breastmilk than Subject #1, this likely accounted for the differences.

Conclusion: Breastmilk, once thought to be so great, is actually a source of infection and developmental delay. Who would have thought it?

MiM Mailbag: Dreaming of Emergency Medicine

Hi Mothers in Medicine,

My name is Christina, and I am a recent graduate with my Masters working as a family practice physician assistant. My dream career has always been to be a doctor, specifically, an ER doc. I avoided the med school route because I knew I wanted to get married and have a family at some point. However, I wasn't in a serious relationship so this was just a distant hope. Now that I finished my Masters and still not in a serious relationship, the idea of going to medical school is still nagging at my heart.

So my question is a little different than your typical post here. I have some worries that going to med school will impede me from finding a good relationship and becoming a mother because I am so concentrated on school. I would love to hear some encouraging stories and words of advice or just good plain reality checks! Did anyone here have the same concerns? Are there any moms here that work in emergency medicine that could share their perspective with me in terms of family and being an ER doc? I am 25 years old and would be applying to medical school this year or next depending on how the MCAT goes this summer. Also, I am thinking of applying to both osteopathic and allopathic schools. Any DO ER moms that can speak about how residency was for them? I admire all of the women on this blog and hope that someday to be in your position: a physician, wife, and mother. I know it's a hard combination, but it's a blessing and is what my heart is telling me! Thank you for any advice you can share with me!

Sincerely,
Christina

I can see clearly now

Today is the last anyone can say to me "You should know, you're a doctor," and I can answer "Nuh uh, not yet."

Tomorrow is graduation.

Tonight will be a dinner party at my mom's house. I am really looking forward to it. There will be people from so many segments of my life. There is someone I haven't seen since elementary school coming. My favorite cardiology fellow. My closest friends from my thirties. A friend from undergrad who knew me when I worked the graveyard shift at Denny's.

Nothing is how I thought it would be right now, but I am still relieved, happy and proud. And, I am thrilled the week of rain finally cleared up, because we are having the dinner party on the back patio.

Guest post: My brain doesn't function anymore

I’ve just experienced one of the most embarrassing (not worst patient outcomes, just down to the core of my doctor-ego embarrassing) moments so far in my academic career.  I need some positive reinforcement, honesty, and maybe reassurance that maybe it wasn’t as bad as it felt.  Here’s the backstory… I wrote MiM about a year ago when I was trying to decide between a fellowship application to Endocrine or applying for the Chief Medical Resident position. I got some really helpful opinions and turns out I got the Chief job and will be putting off fellowship for a few years, probably with some hospitalist work in between. I also, in the meantime, got pregnant again and had our second child. It was all part of the grand plan to get as much paid maternity leave as possible before the bubble of residency is over and to spend more time with my new baby as I could, because chief year was supposed to be more flexible than being an attending... Plus, I’m already super tired and overworked, might as well just do it all now… right? It doesn’t get any easier? (this is my rationale… flawed as it may be)

 

So now baby boy #2 is 3.5 months old, older boy is 3 years old. I’ve been on maternity leave for 8 weeks, and then research for 8 weeks.  It’s been blissful bonding time with baby boy #2.   Now I’m coming up on the end of unstructured time in residency… and today I presented my research at the resident research symposium.  I only had to get some slides together to fill a 20 minute time slot with my results.  Pretty simple. Not presenting at ACP or other Fill-in-the-blank Big Subspecialty Conference.  The slides were good and I had some positive results. Problem is… my brain is not what it was a few months ago. I haven’t had to interface with a lot of people at work in MONTHS. Major clinical rotations were done for me over 6 months ago.  Let’s face it: I have Baby Brain and this phenomenon is real.  With my first son, I started intern year when he was 4 months. So okay, I had an excuse for not knowing anything then, because no intern really knows how to do their job in the beginning. What’s my excuse now?  No one really remembers that I just had a baby 3 months ago. Or that this is my first real public presentation outside of my data crunching at home.  

 

So here’s what happened tonight and why I can't stop crying. Okay, that part is likely hormonal.  But I am honest-to-goodness downright embarrassed…

 

My slides went well. People were impressed with the findings. Then came questions. I am not a fan of public speaking on a normal day, but now I felt like I was having an out of body experience.  I could not think. Initially, I was able to say “yes, good point, that would be an excellent idea for future study… blah blah blah”  Then the Chair of Medicine asks a question. In hindsight, he was prompting me to recall part of the lipid metabolism mechanism which may explain part of why my research finding was the way it was (without getting too detailed).  I couldn’t come up with anything.  My program director then tried to prompt me again to answer with a knowing sparkle in her eye.  She practically winked (may be an exaggeration).  Again – MIND BLANK – nothing… I asked him to repeat the question.  I couldn’t even come up with filler. It was like the dream where you are naked at school. “uh… uh…”  That’s all I could say. I couldn’t believe it. I thought I was going to vasovagal right in front of everyone.  Saddest thing is, I knew the answer; I just couldn’t recall the words.  Maybe I had a TIA. Nah… it’s baby brain.

 

The worst of it:  My next major work project is… presenting GRAND ROUNDS for the medicine department.  In 3 weeks.  It’s a tradition for all the incoming chief residents in my program to present grand rounds and I have been preparing, stressing, and thinking about this for 6 months.  But now I’m downright terrified. I’m so scared my brain is going to fail me again and leave an auditorium to fall silent to simple questions that I should know the answer to. Here I am people – the new face of our Big Academic Internal Medicine Program.

 

I need my brain back.  There are so many patients I need to care for, medical students to teach, a residency to effectively run, and the ABIM to pass in a few short months… I need it back. I need to know that I can still do this job.

 

Niquekee

No more pumping!

I have been given the go ahead by our pediatrician to start giving whole milk in June, so I have two more weeks of pumping, then I am done for good! I'll keep breastfeeding for as long as she wants it or around 18 months, whichever comes first, so I won't be saying goodbye to that just yet. But I refuse to touch that pump ever again.

Things I'll miss about pumping:

1) Automatic excuse to disappear in the middle of the day at work

2) Get to eat whatever I want, yet still had calculated BMI of 18 at last doctor's appointment

Um, I think that's it.

Things I absolutely won't miss about pumping:

1) Always having to do it every day, no matter how crazy busy I am at work

2) Trying to figure out how to pump at conferences (especially fun when power goes out on entire block)

3) Having to carry the pump everywhere

4) Realizing I'm at work and forgot pump at home

5) Storing and transferring pumped milk to bottles

6) Drinking constantly yet still always being dehydrated

7) Waking up 30 minutes early every day to pump

I met my goal of pumping for a whole year. I didn't meet my goal of not supplementing with formula, thanks to unexpected mold growth on my breast pump tubing, but I'm not crying over it. I only used two cans total the whole year. And as I've said before, I don't think there's actually anything wrong with formula.

My older daughter self-weaned at one year, but I have a feeling it's going to be harder to do the final weaning this time. This one is mega clingy... her first word was "mama," and if I'm home, she refuses to be held by anyone else. But I'm not going to worry about that until the winter.

Career day embarrassment

I am one week and three days from graduation. WOOOHOOOOOOOOO!

I am incredibly busy, which means I am also paralyzed in the face of all the crap I have to do, and procrastinating on the internet. Hello!

Yesterday I was a presenter for career day at my 7 yr old son’s school. I wore my white coat, wore scrubs, and brought my stethoscope and other tools. I presented in six classrooms (exhausting!), but started off in my own son’s first grade class. I had an apron with sort of anatomically correct removable velcro body parts, which I used to play a matching game with the kids. If a kid guessed which organ I was describing (this organ is a muscle that pumps blood to the body!) then that kid got to put that organ on the volunteer kid who was the “body” wearing the apron. It was especially fun when we got to the kidneys and the large intestine. Poop! Pee! “EWWWWWWWW!”

There were only seven body parts, though, so I brought in my ragtag collection of toy doctor tools. Several people bought toy doctor sets for my kids when I got into medical school, so I had four plastic stethoscopes, a plastic syringe, toy otoscopes, etc. I passed those out to the kids who didn’t get to put on an organ, so they could guess what they were used for, and was one kid short. So, I gave that kid my coffee mug. I made a joke about how that was the most important doctor’s tool, since it helps keep doctors awake, and remarked on how much coffee I drink.

My son rose his hand, and offered, “She drinks beer, too!” I said “And, goooodnight everybody!” and quickly defended myself. “I didn’t drink any this morning! I didn’t have any last night!” and spent the rest of the half hour trying to convince my son’s teacher that I don’t have a drinking problem.

*facepalm*

Cross posted at Mom's Tinfoil Hat

MiM Mailbag: Living with the in-laws?

I will be starting my pediatric internship year soon, after 6 months out of clinical practice (I took some time off between my 3rd and 4th years to spend time with my newborn and graduated a few months after my classmates). I have a fiance, a dog, and a 21 month old daughter. We are so very undecided about our future living situation. My soon to be in-laws have a house approximately 30 minutes, with traffic, away from the hospital. Since we can't afford to buy a house at the moment, we are considering the following options, one of which I am uncomfortable sharing with others who know me, for fear of judgment. One option is that we all live with the in-laws. I think I would go crazy with this option as the in-laws are a loud, lively couple very much ingrained in their ways. The other option is to rent somewhere between the in-laws and the hospital so that my mother-in-law (unemployed) can help out, either by driving to us or us dropping off our daughter with her. The last option, and the one we are strongly considering, is that I rent a small place near the hospital and my fiance, daughter and dog reside with his parents.

I'd greatly, greatly appreciate your opinions and own experiences with the issue. We need more spaces like mothers in medicine!

Sincerely,

B

Parenting in medicine mentoring panel

I just attended the annual Society of General Internal Medicine conference - a conference that always inspires me. You can tell the values of an organization from its meeting. SGIM is understated (no commercial sponsors or huge pharma-dripping exhibit hall) and the work presented is largely focused on health disparities, improving the health of our society, and education. The opening plenary session was titled "Does the Moral Arc of the Universe Really Bend Towards Justice?" (The answer was a heartening yes.)

One of the sessions I attended was a Parenting in Medicine Mentoring Panel, a wonderful idea with an unfortunate acronym. Nancy Rigotti, who directs the Office of Women's Careers at Harvard and a past President of SGIM, led the panel. Mothers in medicine of various stages of their academic career shared their stories, much like we do here. There was also time for questions in the packed room of mostly women and a handful of men (including one division head who spoke about his support for work-life balance in his department by budgeting maternity leaves and family leaves, into his yearly FTE equation, and contracting with emergency child care services- awesome.)

Some key points that were made by panelists and the audience:

• Being a physician makes you a better mother. That quality of being calm under pressure comes in mighty handy when you’re faced with a teenager who announces, “I didn’t go to school today.”
• Make your partner a partner. Many women echoed this. Some split the weekdays in terms of who was responsible for making dinner for the evening
• Get help to do things you don’t want to do to spend that time with your kids. If you can afford housecleaning help, it is worth it.
• If you find yourself working in an unsupportive environment, find a peer group who all have kids to help cover each other when needed.
• Take risks - in your career path, in life
• There is no one way to do it. We each find ways to make it work with our families and choices.
• Don't delay having your family. Unintentional childlessness or having fewer children than desired happens to mothers in medicine.
• On-site childcare can be a godsend.
• Make family dinners a priority.
• Share our stories, form communities of support. (See: MiM byline)

Finally, this thought was shared: Kids are a gift, not an achievement. In all of these ridiculous Mommy Wars and trying to decide who is doing it better, why not just focus on the gift?

Run Like a Mother

A couple weeks ago, as I was reading the Sunday paper (yes, how 1989 of me),  I saw an ad for a Mother's Day 5 K called "Run Like a Mother."  A Race for 'women only' to celebrate health and motherhood, on Mother's Day. This seemed like an awesome idea, so I called up my running buddies and we made it a date.

The race was happening in a beautiful horse farm that has been converted to a park. What a great way to spend Mother's Day morning, we thought.

Last night as we began to check the weather though, we got a little concerned.  The forecast called for heavy rains.

Whatever.  A little rain wasn't going to slow us down.  I've run many races in the rain, as long as you avoid the big puddles, it's really not a big deal.

As I pulled into the park this morning, I began to have my doubts.  As we gathered at the staring line,  a downpour began.  Next I realized that we weren't running on pavement, we were running through the field.

A boggy field. Wet slippery grass. Mud. Awesome.

My shoes were sloshing, my socks soaked to the core as I rounded the first turn.  At times, I was running in 6 inches of water.

This was not what I had signed up for.

As me, my friends and 200 other crazy moms continued the race, we found our stride. The scenery was beautiful even in the rain. Faithful dads and tots stood with their umbrellas, cheering us on at the halfway mark.

It was definitely a unique experience: how often do I run through a horse field in a downpour?
As I rounded the final stretch with the finish line in sight, I realized that even in my cold, soggy state I was having a blast.

This race to celebrate Mother's Day turned in to a perfect analogy for motherhood itself: it's  messy, much harder than I thought I'd be, but exhilarating and totally worth it in the end.

What was the best part of your Mother's Day?

crossposted at thepregnancycompanion.com

A tired American - an angry rant

Ok, so this is risky, and I’m likely to attract plenty of debate but here I go.

First, why am I writing about this?  Because I took an oath to be a healer.  To me this means tolerance, justice, acceptance in order to achieve a greater good, in order to promote a healthy society.  So, I am just a little irritated today as I look at my country which appears to be at odds with itself.  My anger started while listening to NPR on the drive to work this morning and hearing about all of the discussion resulting from the TIME magazine cover of a model-like mom breastfeeding her three year old standing on a chair.  Criticisms flying everywhere about extended breastfeeding and self-important moms. There is the typical sexualization of breastfeeding with lots of reference to the attractiveness of the mom on the cover, and the usual “if they can ask for it” type comments.  (side note: newborns ask for it too - its called crying!!)  So funny, that anyone who decides to formula feed their infant gets nearly stoned for not going the “breast is best” route.  Then we flip it around and hate on the moms who keep breastfeeding.  I realize I’m using the proverbial “we.”  If this doesn’t apply to “you,” then feel free to ignore.  But for all the rest of us: Lets STOP THIS!  Mothers are always criticizing mothers - breastfeed or not breastfeed, work or stay at home, work a lot or a little, nanny or daycare or grandma, etc, etc.  Even Fizzy’s post last week, illustrated how quickly we jump to judgement.  As clinicians we do know the literature and the evidence, but the first step in being able to do no harm is gaining the TRUST and RESPECT of our patients, and in order to do this there needs to be more tolerance and listening.

Anyway, I’m just all revved up.  I live in the Amendment 1 state.  Justice, tolerance.  I won’t say anymore than that.  Our political system is full of polar opposites, butting heads and refusing to compromise.  We’re arguing over reproductive rights of women... AGAIN!  WHAT IS GOING ON!!!

Can’t we all just get along?