Guest post: Having Babies during Residency: A View from the Bridge

This post is in response to our MiM Mail: Residency limit for leave and having children posted in November.

The problem of maternity leave for residents goes well beyond the good will, or lack of it, of training directors and local programs. Different specialty boards establish minimum standards for residents to be board eligible, and these usually involve specified upper and lower limits of time spent in particular areas. Stipends come from multiple sources and are tied to the work that the resident does, which makes it difficult to set aside money from one year to pay for time doing make up work in another. When a resident goes on leave, other residents have to pick up her responsibilities, and they will not receive compensation for doing so. At the same time, they may not violate duty hour limits.

Program directors, of which I was once one, have to figure out how to create maternity policies that do not violate minimum requirements, do not unduly burden other residents in the program, do not violate other regulations and still acknowledge the legitimate needs of the resident who requests leave. When I became a program director, my youngest child was 4, and the issues of maternity leave were still very fresh in my mind. My first thought was to ask the department to hire a PA or master’s level nurse who could float to cover the clinical responsibilities of residents who took leave. That went nowhere, though I still think it would have been feasible and fair. I then tried to get the program directors organization to survey its membership to see what different programs were doing. The push back was immediate and negative. Programs with generous leave policies were reluctant to publish them, for fear that residents would select them to take advantage of them, multiplying the headaches of trying to make accommodations. Many programs had no policies at all.

I am sad to see that so little has changed in the last eighteen years—soon, my daughters will be the ones who have to deal with maternity leave. Change is unlikely unless more women become program directors and choose to work on modifying the policies of various specialty boards. The family practice board position (see MiM Nov 10, 2014) is one that others could adopt. It suggests that programs might create some creditable elective time that could be spent reading or doing some other scholarship from home. Women should be allowed/encouraged to schedule the more taxing rotations early in pregnancy (and I would suggest also front loading as much call as one can). It is still up to the program how much leave to allow and whether it will be paid or unpaid. The AAFP also leaves unanswered how to deal with what may be competing demands of the law in a particular state and the requirements of a specialty board.

In the end, women physicians cannot expect to be treated more fairly and generously than other women. Having a child during training will never be easy, but we should be mindful that we are generally privileged. We may have to delay some phase of education, or prolong it by working part time, or even chose a specialty or a position we would otherwise not have done, because of having a child. Compared to the pregnant UPS driver who gets fired, or the Walmart worker who has to stand on her feet all day, or the mother who can’t work at all because she can’t afford childcare, we are lucky indeed.

-juliaink

Notes from a Post Parent

With our youngest child grown, flown and on her own, my husband and are truly post parents. Others in this phase seem to travel, or acquire pets, or visit grandchildren. Me? I have houseplants and a jar of sourdough starter in the refrigerator. Parenting is, I realize, a state of mind, and the sourdough swells to fill the space. I am always aware, on some level, that it needs to be fed and may generate loathsome smells if I forget it for too long. On the other hand, if I cultivate it properly, something wonderful may come of it, and indeed, at various points, some things already have. The girls all give us much to kvell about--one is making her way as userfriendly liveware for a travel company, one is out to save the world or pass the bar, whichever seems harder, and third is going to be a professor one day. And I reliably make quite passable sourdough wholewheat bread!

The 5 Trimesters Clinic

When I started in medicine, I thought it might make me a better mother, were I lucky enough to marry and have children. And it has, sort of. But I never expected that being a mother would make me a better doctor.

Six months ago, I organized the 5 Trimesters Clinic, offering psychiatric evaluations to women with problems related to fertility, pregnancy, and childbirth. My co-founder has three young children, the chief resident is pregnant, and the resident who does the work is about to get married. Together our decades of mothering experience have given us a perspective on the whole range of issues that the medical literature on women’s health covers in little Balkanized buckets. (Are you imagining leather buckets with gypsy embroidered covers? I am). Seeing pregnancy and childbirth within the context of an adult life, not as a medical/mechanical problem, seems quite novel to my obgyn colleagues. Seeing psychiatric difficulty as a normal element of pregnancy has been equally intriguing to my psychiatry peers.

Having been there, done that, bought the tee shirt and had to wash baby fluids out of it, I have an interest in many problems that are simply off the medical radar. I am, for example, interested in “Motherbrain,” the transient cognitive impairment some women experience after childbirth. The medical literature pooh-poohs this, but I believe it is real, because I had it. More importantly, it needs to be acknowledged so that we don’t expect new mothers to pass high stakes exams or the equivalent before their babies sleep more than 2 hours at a time. (The scientific studies of this problem excluded mothers who were depressed, the population most at risk for sleeplessness and poor concentration—duh.)

Our clinic pays attention to many matters—the role of fathers and grandmothers, women’s anxieties about bonding during pregnancy, new mothers’ loneliness—that come directly from the experience of those who run it. To integrate mothering with doctoring brings me enormous satisfaction. The greatest joy is passing this wisdom on to the resident embarking on the same journey. My kids are grown, but I am and will be until retirement, a mother in medicine.

I am, too, committed (or maybe I should be)

I’ve been away for a while now, birthing, or perhaps mid-wifing, two books. For me, editing seeps into writing and rewriting for others, to the point where I am not sure whether I wish I’d said that, or I did say that. What on earth was I thinking, involving myself in two projects with competing deadlines, and then volunteering to write an index?

Now that everything is in the uber-editor’s inbox, I can blog again. It feels like when my last child got her driver’s license and could get herself to school on her own, or when my first child finally slept through the night, or the day they all were in school for a full six hours, or the first weekend that they all went to grandma’s, or…

Here is what I didn’t have time to write in May: At graduation, I again heard the speech about putting patients first, sacrificing ourselves to medicine. I could see all the graduating students, especially the women, looking vaguely shifty-eyed, wondering what those exhortations would mean to them and their hopes for a full and balanced life.

I think beyond valuing the contribution of privileged males, medicine suffers from its institutional history. The structures of medicine and medical education are eerily like those of the Catholic Church and the military—institutions in which celibate young men with great physical stamina have the greatest value in perpetuating the institution. I do believe in the value of altruism, selflessness, and commitment—but I also believe these can be expressed in many contexts. When I am in the office, I will do for my patients whatever I can, above and beyond what they pay me to do. When I am on call, I stay late. But I do not think that I am any less of a dedicated professional (a word originally applied to priests) because I also worked part time for many years while my children were younger, pursue hobbies now that they are grown, and comfortably wear many different hats and uniforms, depending on the day.

I wish that just once the graduation speaker would say this out loud—it is, after all, what all of us, men and women, really do and mean in our lives after training.

Anybody worried?

One of my first year students was a former surgical nurse, in her 30s, who had had to defer her dream of going to medical school because she had gotten pregnant as a teenager and was raising her child. Though she graduated, did a challenging residency and now has more children, I wonder how many other young women with the dreams we all started with are stopped at the gate by unplanned pregnancy. The recent political discussions about removing all federal support for Planned Parenthood has left me and my pediatrician sister both feeling like our hair is on fire. My student was exceptional in many ways. She did not have the luxury that we have had to worry about when it might be best for us to have our families, or the tools to make our choices feasible.

Choice about childbearing comes in many forms. In my own case, it was because I came through training at a time when professional women had trouble finding men who valued us--or maybe it was my evil temper. In any case, I married quite late and had my last child at age 39. This is not necessarily the path I recommend, but I do think that if we support women's professional aspirations, we should be committed to the proposition that all women should have access to reproductive health services. If Congress prevails, many women who might otherwise make up the next generations of mothers in medicine are going to be instead mothers who lack education, income and the privilege of being able to care for others as well as their own children, in the ways we all do.

I have been writing letters opposing the Congressional initiative to defund Planned Parenthood to my congressional representatives. I hope those who read this will be moved to do the same.

Which form of Competition is Best?

Just came back from watching my daughter compete in ballroom dance competition. It struck me as a cross between a swim meet and an evening at the theater. I can’t decide if turning an art and a pleasure into a competitive activity is a good thing, or not. 

Which got me thinking about medicine, as most things do. Because what we offer is such a scarce resource, we inevitably select people who are, quietly or openly, highly competitive. Then we continue to rank them, in tiny increments, right through the end of training. At the other end, the money and perks that go with practice, or not, seem to play right into the same attitude. 

On the one hand, competitiveness has made my daughter a fine dancer, and my own competitive streak keeps me pushing myself to accomplish things I might otherwise not. But I do wonder if the drive, not only to excel, but to outshine, is a barrier to learning really important things—like the value of doing something for its own sake, or just being with our families, our patients, the people we work with. By the time my kids finished swimming competitively, they no longer could swim for fun. As a friend, I never learned to hang out; now I only seem able to be friends with people while I am doing something. And much as I try to be receptive with patients, I keep them and myself to a very tight schedule.

What bothers me most is that medical students are so conditioned to rely on their competitiveness for motivation, they can quickly become indifferent or hostile to anything that does not seem to have immediate value for giving them a leg up. The idea of studying anything because it is of intrinsic interest, or might someday be useful, seems to fall away quickly in the first semester of school, and may never return. Since it is especially hard to compete on the basis of creativity, which, by definition, confounds existing standards, this, too, seems to be systematically discouraged in our students. Creative problem solving is an essential element of practice, not just a frill. But to ask “how can we reward creativity?” immediately puts us back in the position of selecting, rating, and favoring, the same dynamic that fosters competition.

Resigning totally from a competitive environment—the ashram approach—never appealed to me. It always struck me as a paradox of people competing to show how anti-competitive they were. I just wish our education—the one we had and the one we offer—allowed us to allow ourselves to freewheel more, and enjoy it. As recent posts and discussions have highlighted, being present in our immediate lives—reading chicklit, not postponing everything in hopes of a future haven, or choosing family time over work--is an important counterweight competitiveness as the root of our motivation, and our rewards.

I am 22 years post partum and still worried about mood

I just came back from a research conference put on by the Marce society on the topic of perinatal mood disorders. It was great—the science is growing rapidly, and there are lots of clinical programs that are trying to promote recognition and treatment for women across the social spectrum, here and around the world. The human genome project is really bearing fruit.

Even as I got fired up (again) on this subject, I felt my usual sorrow and frustration that most pediatricians and obstetricians don’t screen for these disorders, even though they see the women (and their fetuses and then children) at risk, repeatedly. Today, many more obstetricians and pediatricians are now mothers themselves. Yet the demographic change in those professions doesn’t seem to compensate for the dis-incentives, blindspots, and confusion that discourage psychosocial pregnancy care.

I hope I am wrong, and that this area has just become so routine that my younger colleagues address it well and take it for granted. Is it?

PS: PLEASE VOTE ON NOV 2

Seeking inspiration for inspiration

We have a new first year class staring in two weeks. A colleague asked me to suggest something they might read about a physician to provide inspiration. We agreed that books about heroic doctors going to dangerous places were not suitable, but I couldn’t come up with anything else. I also realized that most doctor-heroes—at least the ones who inspire others to write about them—are men, often men motivated by religious faith or medical missionary zeal. The women doctors who have fascinated and inspired me all come from the pioneer period, when just going to medical school was itself an act of heroism. For this class, in which women are the majority, those kinds of accounts would likely seem quaint at best. Who inspired you? And who do you think might foster the spark in the class of 2014?

More Fun Than Playing Polo With the Duke

I hope it is not too late to toot my own horn, and say that of my own posts, I most liked the Laws of Mommodynamics. I really love it that this blog has let me pontificate, ruminate, contemplate, exasperate, adumbrate, and simply prate. I look forward to our third year--we rate!

Another Speech I Never Gave

Back from another commencement, where I heard a great speech on neglected tropical diseases and the possible impact that doctors who treat them could have on child health, world poverty , and thereby war and other ills. As inspiring as that was, I wish I could have shared a very different experience with the graduates.

A couple of weeks ago, I evaluated a refugee applying for asylum. He was an accomplished professional who had been persecuted and harassed for decades in his home country, because of his activities against corruption and mistreatment of others. Before he finally fled, leaving his wife and children in very perilous circumstances, he was detained and tortured. Upon coming to this country, he was detained again, in stressful and humiliating conditions.

He recounted his entire history with little affect, breaking down only once, as he talked about losing his family and his country because of his beliefs. As part of my evaluation, almost by rote, I asked about his medical history. Since coming to the US, he had had to make a visit to an emergency room. Although the hospital knew he was destitute, they were still dunning him for the bill. This bothered him terribly—-not as much as being tortured, of course, but it was by no means a trivial stress.

He mentioned that the hospital had found him to be hypertensive but did nothing about it. Though not part of my usual protocol, I put on a cuff and found that his blood pressure was indeed way up. At the end of the interview, I spent a few minutes scouring the internet and calling around, and was able to get him a follow up appointment in a free clinic. After I completed my affidavit for his attorney, I received a message: “He was very pleased about the appointment for his blood pressure.”

This comment really struck home. My simple act of medical care, freely given, was something a first year student could have done. Yet it seemed to redress in some small measure the injustice and the tragedy inflicted on this man by his countrymen, and by the moneychangers in our own temple. I wanted the students, now doctors, to reflect on the profound impact that they will have on others, even if they don’t cure thousands of children of parasites, or never perform lifesaving surgery, or make a million dollars. Moments of grace occur in every field of medicine, in the most unexpected ways. Recognizing them and, occasionally, sharing them with others, is a feeling like no other.

That’s what I would like to have said to the class of 2010.

Mothers in Medicine; Daughters in Life

All the years I was growing up, my mother was active in the Parents Auxiliary of the school I attended with my three siblings. When she finally had to give up the house where we grew up, she moved into a nearby development. No less than three of my classmates’ parents live in the same place, and the number of people who had children in my school is much higher. Yesterday, I attended a memorial service for one of my mother’s friends. A classmate was there comforting her own mother. A former teacher from the school is also there; he gives classes that my mother attends. Suddenly the Parents Auxiliary has become the Daughters’ Auxiliary.

I wish I thought that the time I have invested both in my childrens’ institutional life and in my own will provide similar sources of connection when I am older, but I can’t see it. Being a doctor is isolating—many of my most longstanding and intimate connections are with patients. My colleagues and I work quite independently. I hardly know my colleagues’ families or the parents of my children’s friends—certainly not the way my mother did. My husband is also a busy professional—he is a little more connected, having coached my children on various teams—but at this point in our lives, we rarely see the other parents whose children shared activities with ours.

Maybe it will be different when I am much older, or maybe I will find in myself a gift for making friends outside of work, once I am no longer working. I suppose I should stop worrying. If I live long enough that I need to find new ways to connect to people, outside of doctoring and mothering, that will be a blessing in itself.

Matching to a Different Drummer

 Hi and thanks for the blog, I love reading it when I get a chance to sit at my computer and procrastinate!

My question is this- I'm a caribbean med student from the midwest, and due to odd scheduling, I'll be done with my 4th year electives in July, taking step 2 at the end of that month.
This means I will miss this years' match, of course.
What should I do for the 10 months that I have off before residency starts in July 2011?

Get a job in research at the hospital that I'd like to get a spot with?
Get a job as an EMT?
Get a job with nothing to do with medicine and study like mad to take step 3 before residency starts?
Is it possible to start residency in September?? ( I want to do Peds)

I'm single and childless- but I have joked that those 10 months off would be the perfect time to be pregnant! :) Current BF grins while looking green... lol. I'm not looking to have a kiddo yet, just seems from reading your stories that this is the last time I'll have 10 months off in a row!

Thanks for any replies!! I appreciate you all.
AftenMD

Being out of step with the match can work to your advantage in several ways. Some positions do open up in the middle of the year, when people drop out, switch specialties and so on. I am not quite sure where such positions are advertised, but the dean of your school may know, or you can check in a specialty newsletter. If you have graduated before you apply, you are not obligated to go through the match at all. This frees up a program director to take a position out of the match and sign you up at any time before submitting a match list. If you are applying to a residency that has trouble filling slots some years, this can work to everyone’s advantage. Programs hate to have positions unfilled on Match Day, and it also frees you up to do whatever you want, knowing your position will be there in July.

If you are looking for interesting things to do, there are many opportunities in international relief related medicine, including disaster relief, maternal child health clinics, HIV clinics and so on. The internet is full of requests for people who want volunteer in Haiti, and the need is going to be there for years (try Partners in Health as a sponsor, in particular). You can also use your time to get far along with another degree—for example, if you take a full semester of courses toward an MPH, you will likely be able to finish it during residency, and that is a great credential to have later on. You could also take courses in humanities, again with the idea of cultivating medical humanities in residency and teaching in this new field in the future.

Another or additional activity is to learn to be a standardized patient—the work pays something, is very flexible, and teaches valuable patient relationship skills that may be helpful during residency. Other medically related, paying jobs that a medical student is qualified to do include phlebotomy, being on an IV team, and being a “sitter.”

Finally, there are some educational experiences that you could pursue if still enrolled, for example, the neurology elective at the Queen’s Square hospital in London or the advanced psychopharmacology clerkship at the National Institutes of Mental Health. Students also can go to some professional meetings for free as recorders—the Child Psychiatry meetings for example—and that could really enrich the time between school and residency.

Snowday without Children

Ode to Warm Socks

Stuck in this Blizzard, sleeping on cots
The joy of my day—a pair of warm socks.
Stuggling through blizzard from office to ward,
My job lies before me, those names on the board.
My feet feel so damp, cramped into these boots,
But a doc can’t go sockfoot, the patients would hoot.
The nurses are heros; they work shifts end to end,
While after my rounding, I’ve no one to tend.
So I slip off the boots, put the socks on the heater
Spend a few hours to make my space neater.
Still it keeps snowing, in buckets, in torrents
We’re glued to the news in a state of abhorrence.
But me, I’m contented, my children are grown
I fine where I am, don’t need to be home.
I can just watch the snow fall, all night by the clocks
And wait for the day with my pair of warm socks.

The Fourth Law of Mommodynamics

For years now, I have lived by the laws of Mommodynamics:
1. Energy is finite.
2. Clutter, like entropy, tends towards an infinite maximum.
3. Matter is neither created nor distroyed, it is merely misplaced.

Now, to my amazement, I recognize a fourth law has been operating all along, behind the other three: the law of conservation of clutter. This law requires that every time I find a lost object, an object of equal importance will go missing. This weekend it was my watch, which turned up under some papers on a countertop, and my cell phone, which instantly disappeared from my coat pocket. I have noticed the same sly switching going on with my faculty id and my drivers licence, my ward key and my office key, my metropass and my credit card--whenever I have one of these ready to hand, the other one slips off into the shadows for a giggle and a rest. After a frantic search which rivalled the rummaging of a cocaine addict in search of a fix, I just found the missing cell phone, under a potholder in the kitchen. I can hardly rejoice--lord knows what has just gone missing in its place!

Why I Thought I Would Post My Holiday Letter, Then Decided Not To

I consider myself a connoisseur holiday letters, which I have sent and received pretty consistently since I first had children. Since my friends and I are roughly of an age, most of our children have left, or almost left, home. This year, I am struck that my letter and the ones my friends send still focus on the doings of our kids, with some people adding a bit of travelogue or home repair updates. It makes me wonder if having children means that ever after, we live and see the world through others’ eyes, sometimes at the cost of closing our own. I know holiday letters are not an intimate genre, particularly not the mass produced kind, but it seems that I and my mother-friends reflexively place ourselves in the background and move the kids to the foreground of our lives and our relationships. This posture of stooping over our kids becomes so engrained, it is hard to straighten up and reclaim interest in our thoughts and feelings after the kids have grown.

Being in medicine complicates things a bit. My non-medical friends would be baffled if I wrote about how amazed I am about the way that we are finally understanding the illnesses I treat at a genetic level, or how I believe I have experienced an inner paradigm shift in my understanding of psychiatric disorders since I discovered evolutionary biology. But other professional friends are equally reticent about their inner lives—they may report promotions or job changes, but not how they have been evolving and changing themselves.

In the end, I can’t decide whether the loss of interest in one’s self, or perhaps just the expectation that no one else would be interested, is a natural part of growing older, an artifact of being mother, the result of being in a fairly esoteric profession, or simply my own view of things. In the end, being a mother/doctor seems to have greatly expanded my sense of who I am, but with some loss of the value I once placed on reflecting about my experience and sharing it with others.

Of course, nowadays I can blog about it, and leave the kidalogue for my holiday reports.

I’ve Got to Crow: Notes from the Empty Nest

One of the great advantages of now having self propelling children is that I can go to conferences that rekindle my interest in more general professional topics. I just attended a meeting sponsored by the Society for Women’s Health Research on the topic of adherence to medication—what in the not so distant past was called compliance. Improving adherence to medical advice offers great promise as a strategy for reducing health care costs. And I was delighted to find that women physicians already excel in this area.

At the meeting I learned about a big review article (Roter, Hall and Aoki, Physician Gender Effects in Medical Communication: A Meta-analytic Review, JAMA 288:6 756-64)that showed that women physicians, at least those in primary care, spend more time with patients (10% longer visits—an average of only 2 minutes more per encounter). The researchers found women were better at enlisting patients as partners in their care, asking about the social context of illness, and focusing on emotion. I remember, still indignantly, being scolded by a resident for spending too much time “chatting” with patients on rounds. This study—a meta-analysis, please note-- firmly laid that shibboleth to rest. The extra time we spend with patients is not merely social conversation. Women use time with patients well, conveying medical information as thoroughly as male physicians. While the effect on medical outcomes was not reported, other people at the meeting provided compelling data that communication promotes adherence, and adherence promotes health and lowers costs.

These data are something we can all be proud of. I confess I would love to go back to my obnoxious resident and say it out loud: “So there !”

Looking to History for Mothers in Medicine

Here are few remarks excerpted from a talk I gave about a travelling National Library of Medicine exhibit on women in medicine that is currently at my school and may come to others. The exhibit is very worth a visit, even from an overbusy motherdoc. The students in the audience seemed to share my thoughts--many are struggling with the same concerns we have all had about integrating our many roles:

"I graduated from medical school in 1977. A picture of my class could have found a place on one of the panels of a history of medicine exhibit, as it was, I believe, the very first class at my medical school to have more than a token number of women—30% rather than 10% or fewer. What that meant to me concretely was that my male classmates could look around at their peers and professors themselves for models, inspiration on how to build a life and a career in medicine. In school, I could look to my peers for ideas on how to remove the smell of formaldehyde from my hands. Later they showed me how a woman can be an effective teacher or begin a research career, but for inspiration, I had to look backwards in time to the women sporadically flung up by the tides of history. Reading about the checkered history of strange and sometimes misguided study and treatment of disease by strange and sometimes misguided practitioners helped me form a realistic view of medicine, to lose the naïve assumption that one had to be a genius to enter this profession and that once in, one could never make a mistake.

Elizabeth Blackwell, of course, was the subject of various biographies for children that I read in elementary school and every other book about women in medicine that I read after that. I admired her determination and commitment, but I was always troubled by her detour away from what was called allopathic medicine into homeopathy, as well as by her unmarried and apparently unmarriageable state. In my college, which had originally been an all women’s school, I stumbled across Dr. Edward H. Clarke's publication Sex in Education; or, A Fair Chance for the Girls (1873). Clarke was a professor at the Harvard Medical School, and seems to have been panicked at the sight of blood. Aside from unbending prejudice, that was the only way I understand his argument that women were so weakened by the menstrual blood loss that they could not possibly tolerate the rigors of secondary education, much less enter any of the professions. He suggested all women should lie in a quiet room for a week every month, to conserve their strength to bear healthy children. Clarke’s contemporary on the faculty, Oliver Wendell Holmes Sr, clearly knew this was nonsense, but all he ever did to counter it was to state in his eulogy for Clarke that he knew Clarke sincerely believed in his own thesis. I was thrilled when I learned that Mary Putnam, another early woman physician, had demolished Clarke’s work by rigorous research conducted during her post graduate training in Paris. Her complete and influential refutation of Clarke in fact laid the groundwork for the creation of elite women’s colleges around the country, and accounts for the emphasis they placed on athletics as well as scholarship.

Still looking for models for myself, I was also very relieved to read that Putnam not only succeeded in influencing the whole of her profession, she also married and was the mother of two children. Still seeking a guide on my own path into medicine, I found her story a bit intimidating, given that I could not imagine having her commitment to science, or her critical intelligence. She saw clearly the inadequacies of her own training in the US, and went off to remedy that in nearly complete isolation from friends and family, not to mention other women physicians.

Regina Markel Morantz’ article comparing Elizabeth Blackwell and Mary Putnam Jacobi clarified a lot for me. These two women represented different poles of feminism—ones still relevant in my era in college in the 1970s and even today. Blackwell was a “difference” feminist who believed that women’s unique nature would lead them to be more understanding, more gentle and feminine in their professional practice. Ironically, since Blackwell herself was never a wife or mother, it was Putnam (Jacobi) who was what has been termed an “equity” feminist. Despite (or perhaps because) of her personal adoption of the conventional roles of wife and mother, she successfully argued and demonstrated that women deserved the same opportunities to achieve as men, given their equal abilities. I could only sit on the sidelines of history chanting the “right on!”, the 70s equivalent of “You go, girl!’, though I did become convinced that I could handle being in medicine, and would not have to abandon my hopes for a family as well."

I wonder if other bloggers find history as important as I do as a way of understanding the way our current context influences how we feel about ourselves and our choices?

I Didn’t Join the Circus, So Why Must I Jump Through These Hoops?

One of the things that troubles me most as a teacher is watching medical students’ enthusiasm and curiosity deteriorate during medical school. Within about three months, I see them going from thinking about what they are learning to trying to pare down the material to what is likely to be on the next test. The competitive habits that got them into school provide a deeply debased motivation for studying—without knowing why, they fret about being AOA or getting into a competitive specialty . Few of them live in the present—as preclinical students, too many want only to survive to move to the clinical years. As clerks, they worry about buffing up their records to get into residency. Once in residency, I wonder if they ever recover the vitality that comes from being fascinated and engaged in learning something, thinking a new thought, or enjoying the unfolding of a new relationship .

Given the deadening effect of our current way of educating— or to be precise, training—doctors, I understand why the competing challenges of mothering appeal so strongly. With children, we have to live in the present (though we do also eventually transmit to them worries about their future and risk turning high school into nothing but a springboard to college). We can’t stop to study them for the next exam. Their development and our relationship to them propels us forward, and it is only in looking back that we see how much we may have learned in the last few days, weeks, months or years.
A lot of paper and ink is currently wasted by people pontificating about “adult learners,” postulating that they learn differently from children—because they have to incorporate new information into older structures and because they need to learn by doing rather than by rote. I often find myself doubting whether any of these theorists (mostly men, I might add) have actually watched children explore the world, puzzle out new information to figure where it fits with what they already know, and joyfully practice new skills.

I wish that I could be creative and persuasive enough as a teacher who draws on experiences as a mother to enlist others to think differently about how to engage and encourage students . Rather than spice up our lectures with video clips to entertain them, we should think about creating relationships with patients, peers, and mentors that both stimulate their felt need to learn things and reward them, immediately, for doing so. I know that a medical student will never learn the complexity of our profession in the unselfconscious, apparently effortless way that our children learn in their early years, but I think they long for it to be so, and I long to able to make it that way for them. But even if that is not possible, we need to think more about motivating them by stimulating curiosity rather than fear of failure, rewarding learning immediately rather than in the distant future, and engaging with them as teachers so that they in turn will engage with patients and be the doctors we would want to see when we get sick.

MiM celebrates one year: Juliaink

The end of this month marks Mothers in Medicine's one year anniversary. In honor of this great occasion, I asked our writers to share their favorite post (of their own) from the last year. Throughout the month, I'll be highlighting their picks.

Juliaink has brought a unique perspective to this blog, both as a psychiatrist in academics, as well as mother to two grown children. She writes eloquently and thoughtfully, and at times, passionately.

Juliaink writes:
I think my favorite is still The Speech I Never Gave though I also like the one I did on mentors/models.


The Speech I Never Gave gave me goosebumps and one I wish was required reading for every female medical student. And her post on mentors was honest and rich.

Thank you, Juliaink, for having the courage to write about what moves you, and to share your opinions on issues seen through your multiples lenses as a mother, physician and concerned citizen. Thank you for your stories.

Confessions of A Recovering Mother: Warning May Contain Political Content

At this point, with my children living between 300 and 6000 miles away, I find myself recapturing concerns that were submerged in the day to day tasks of mothering. I have always been concerned about politics, and as my children are becoming more independent, I process most political concerns through the lens of "what will this change mean for them?" I am especially concerned about health insurance reform, now that two of the three are no longer eligible for coverage under our family policy.

I am uncomfortably aware that my interests as physician, mother and citizen are diverging. As a physician, I want beneficiaries to be able to see me at reasonable rates with minimum hassle for both of us. Out of network coverage, health savings accounts, and any other mechanism that subverts managed care seems the most desirable when I am sitting behind my office desk.

As a mother, on the other hand, I am devastated that the last remaining not- for- profit HMO in my state is being dropped by the employer who provides our insurance. Growing up, my asthmatic daughter never had an attack before 6:30 in the evening. Only by the grace of Kaiser did she avoid emergency rooms and hospital stays. The idea that we (and she) no longer have an evening urgent care clinic to go to gives me shivers. She has had several ER visits since moving away and has no regular doctor. No one but me now reminds her to have check ups and refill her prescriptions, as the HMO used to do.

Then there is citizen me, who believes that national, single payor health insurance is the only way to correct the disparities that deny care to so many—including my middle daughter who is likely to be uninsured when she returns from abroad and has not yet found a job. As a doctor, I am wary of having the same type of people who man the kiosks at the DMV involved in managing health insurance, but as a mother I would welcome it, if it meant this child would not be uninsured, however briefly that is likely to be.

Like everyone else on this blog, I wish that politics did not divide and distress us. But some day in the not too distant future, I expect to have to vote on what it is I really want to see in health care reform. To the extent that my identity extends beyond myself to my children and my community, I frankly have no idea what it will mean to have the courage of my convictions. It would certainly help if I actually knew what those convictions were.