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Stop the Stigma of Mental and Chronic Illness

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I’m a doctor. I have mental illness and chronic illnesses.  I am not ashamed.

It’s taken me years to get to the point in my life where I can say that and not feel shame. Where I can state it as fact and not apologize for it. 

The healthcare industry, and for that matter our society, is a wealth of contradictions. One of them being that healthcare professionals themselves are not allowed to be ill. How many times have you been sick and come in to work anyway? You know that if you call in sick, there is little chance for anyone to replace you, and that your whole team will have to work understaffed. If you are an independent doc, there is no one at all to back you up, and so your patients are forced to reschedule or go to the ER. 

Long term, chronic illness is meant to be buried away and hidden. We tell our patients that they should be open with us, that there is no shame in having an illness, but would we do the same for our colleagues? For as much as our healthcare systems have recently been on the wellness bandwagon, how many of them provide the day to day support for chronic illness? We are good at banding together in acute emergencies, but what about those long lasting issues that will be present for years or even a lifetime? 

Why can’t we acknowledge that we are human beings first? People are fallible, people get sick. It is not a personal failure, it is a fact of life. 

In the last few years, I have found the strength to acknowledge my health issues. Via social media by talking about it openly at work and home, I have admitted that I am in fact not an endless source of physical and mental well-being. I have bad days. I have migraines. I have chronic pain. I have anxiety and panic attacks. Conventional wisdom would tell you that this makes me weak. That it is somehow a failing of my own that I have these issues. That I should keep it to myself. 

But why? I am still the same person. I am still the same physician. Having chronic illness does not make me any less of a doctor. In fact, it’s made me have more empathy and be able to talk and connect with my patients on a real and intimate level. So let’s stand up for ourselves not just as medical providers, but as people. Let stop the stigma of mental illness and chronic illness, for everyone. 

Support Abortion Providers

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I am a family practice trained Hospitalist physician now, but there was a time in my medical residency when I briefly worked at the abortion clinic in my city of Dayton, OH. I was already strongly pro-abortion before, but that experience cemented it for me. That clinic and others like it provide 100% necessary medical care to women. Women who had found birth defects incompatible with life, women who were raped, teenagers who stupidly knew little of how to protect themselves from pregnancy, women pressured by their partners to not use birth control, and women who just didn’t want a child. Women who were religious and sobbed in agony afterwards because they thought they were murdering their child, and women who had the understanding that an embryo or fetus is merely a clump of cells that has no life or meaning outside of its protected environment in the womb. I have also been on the other side, and seen children killed by abuse, children suffering neglect or placed into foster care, and children living with severe birth defects or chronic diseases. I came to realize that every woman has an abortion for a different reason, and that every single one of those reasons is valid.

After that rotation, I came very close to changing my focus and becoming an abortion provider. This had always been at the back of my mind, but in the end, I was too scared. Would I lose family and friends? Would I get constant death threats? What if the irrational protestors attacked me or my family? Would I even be able to find a job with abortion clinics closing all over the country? If I ever wanted to practice a different type of medicine, would I be able to or would I be blackballed? I didn’t have the grit to commit myself to such a risky practice. I still think about it, now more-so than ever. Abortion is a fundamental right of being a woman in America. A right we have fought and even died for over the years. In Dayton, OH right now, the only abortion clinic is going to be forced to close its doors any day now. Not just because the Ohio “heartbeat law” bans abortion after six weeks, but because the clinic has lost a case in court to remain open. The two major health systems in town, one of which I work for, have refused to provide transfer agreements with the clinic. This means that even though the abortion providing physician is licensed and qualified, no hospital will deign to accept his patients if a complication arises. In light of this, the courts have ordered the clinic to close its doors. Abortion, and the women who need it, are under attack all over this nation. It is extremely heroic to choose to provide abortion care in this country, and I thank the providers who have been brave enough to offer this vital service to their patients. I hope that we all band together as healthcare providers to support the physicians on the front line of this contentious issue.

#abortionishealthcare

My First Code Blue

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Stepping into a hospital for the first time as a clinical medical student is a strange dichotomy. There is still so much you have to learn before you will become a physician, but you are quickly thrust into life and death situations. One of my early rotations was in the emergency room. As a student you have no actual authority and must be closely monitored at all times. Many times you will just need to step back and observe and stay out of the active personnel’s way. 

In one of my early shifts, in the ER at our large downtown hospital, I found out what it’s really like to work in medicine. It was near the end of my shift when an ambulance brought in a man to the trauma bay. He was rolled in on the gurney with the EMT kneeling over him doing chest compressions. The ER staff swung into action. He was transferred from the gurney to the table and a swarm of a dozen personnel were in a flurry around the bed. One nurse was doing chest compressions while another was trying to place a peripheral IV line and several more were gathering medications and supplies. The ER resident and doctor were at the head of the bed intubating the patient in between the violent rhythmic jerking movements of his body with the chest compressions. Another resident was at the patients groin, trying to get a femoral IV line in place. The patient was a healthy man in his 50s who had collapsed suddenly at home while mowing the lawn. As sometimes occurs, his bowels has evacuated so the room smelled of feces initially and soon the scent of blood from an unsuccessful femoral line attempt commingled in the room. Occasionally the flurry of activity would pause as the team checked to see if any signs of life were present, looking for a pulse or signs of cardiac activity. The patient’s heart was in ventricular fibrillation so the attending doctor yelled “all clear” and a jolt of electricity shocked through the patient. His body jerked and then the staff resumed their compressions. 

Trying to revive someone is messy, physical work and the staff needed more help. I was called to the bedside to do chest compressions. Standing atop a small metal stool I concentrated solely on the strength and rhythm of my compressions. Activity continued all around in controlled chaos as medications were found and administered, the breathing tube was secure in place, and blood samples obtained to send to the lab. While securing the patient’s airway, the doctors had caused some trauma to the airway tissues, so blood was filling up the tube and bubbling out with each compression. The respiratory therapist suctioned to try and clear the bloody secretions and allow for air to move, blood was constantly splattered on the staff and the room. Time seems to slow down during a code blue. We each know how precious each single minute is, as with every passing one the brain is deprived of critical oxygen. This patient had been down for approximately 10 minutes before the ambulance had arrived to his home. By the time our ER team was working on him he had been without oxygenation and cardiac activity for 25 minutes. As time in a code goes on, it slows down even more. The rhythm of the team is established and everyone is perfectly in place doing their role. At a certain point the attending will call again for time. It had been over 45 minutes since the patient was found down in his yard. “Hold compressions and check for pulse” said the attending. Silence. No electrical activity of the heart, no pulse, no breathing. In those last seconds, silence overtakes the room. “Time of death 1746”. 

The doctors cleared quickly from the room, they had other patients they urgently needed to attend to. In the quiet the nurses went about removing the invasive medical equipment from the patient’s body and cleaning the body fluids and debris. They worked with a quick efficiency, but showed small compassionate gestures like closing the patients eyes and resting their hands on his forehead for a moment. I had stayed in the room and was helping to tidy up. As I was disposing of some used medical equipment, the attending physician was speaking to the family in a holding room next door. I could hear wailing seeping through the walls. The sounds grew louder, and when the nurses had finished making the body presentable, the patient’s family was led in. His wife and several children huddled around the body, overcome with grief. A nurse stood close by, keeping her arm on his wife, to steady her and offer support. Simultaneously as the family came into the room myself and the other unneeded staff members exited. The family, who had last seen the patient laying dead on the front lawn, were reunited to spend their last moments together in the ER bay. 

At this time, the end of my shift had come and gone. I quickly touched base with my attending and walked to the parking garage. I sat in my car. A wave came over me. I started sobbing in the garage. I had just witnessed my first patient die. I couldn’t forget the sound of the wife’s wailing screams. The violent physicality of the resuscitation attempt, with the forceful chest compressions, the invasive devices being inserted into the patient, the body fluids co-mingling in the room was traumatizing to witness. This patient had been a young, otherwise healthy father and husband, to know his life was gone in an instant and that his family would never see him alive again hit me like a truck as I sobbed in the garage. And then I did what everyone in medicine does, I went home and I came back the next day and did it all again.

The Pros and Cons of Needing Medication

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Part of the reason this year has been so deflating for me is the need to go back on medications. Last year, I was able to get off all my medications and be prescription-med free for over 8 months. With this year bringing the challenges of worse and worse migraines, anxiety, acute on chronic pain, and weight gain which had led me back to pre-diabetes, I am now on more medication than I have ever been. 💉💊👩🏻‍⚕️
On the one hand, these medications have helped me in many ways. Especially with my anxiety, I just could not function anymore on my own without the medications. Before I was in a state of 24/7 panic attacks, and the biggest change I’ve had on the meds is that I am able to be calmer and sleep better for the first time in my adult life. It doesn’t stop the worry or the racing thoughts, but it has helped them significantly, especially the physical symptoms associated with my anxiety.

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Why does it feel like such a failure to have to be on medications? I recommend and prescribe them for my patients every single day. I guess I’ve always had the attitude that I could overcome anything on my own. It’s humbling to know that it’s the true. For now these medications are necessary and are helping me to get my health back on track. In the end that’s what this has always been about. My quest to lose the weight and keep it off has never been about looking better, it’s always been about feeling better and being as healthy as possible. 💪🏻🏃🏻‍♀️👩🏻‍⚕️

#drjennygetsfit

Normalizing obesity and fat acceptance- is it a mistake?

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I cannot get behind fat acceptance, or better stated in medical lingo as “normalizing obesity”. As a physician and as someone who has been obese or morbidly obese my adult life, I know first hand what it’s like to hate my body and feel ashamed of it. I still do this very moment as I type this, that’s something I have to work on. Funny thing is, I am much more understanding of my obese patients than myself, and I think my own struggles make me more empathetic. There is a place in which you can encourage people to lose weight without being cruel and judgmental.
I would never tell myself or any patient to accept that their body is destined to be obese and to just make the best of it. Just as I would never tell a drug or alcohol abuser to give up on sobriety. Obesity in this country, at its core, is caused by addiction to foods- to processed sugary foods and to lifestyles that are less and less active and more sedentary. There’s a reason we are now using naltrexone to treat obesity just as we treat our heroin addicts- it curbs the cravings. We are still learning more about why some people are more susceptible to obesity, and I hope in years to come research will continue to shine more light on the subject. In the meantime the vast majority of us obese people need to find our version of the winning formula that works: less calories in, more calories out.
I think the bigger problem this article is alluding to is bias against obese patients. As I’ve said before, that’s a real thing and a huge problem. It makes me sad to see how obese people are treated in this country; we are treated the same way that we treat drug abusers, alcoholics, smokers, and the mentally ill. No one chooses these problems. But I hate myself for being obese, so I can understand why other people would hate me for it, too. As everyone has seen the last two years, with a healthy calorie-counting diet and daily exercise an obese person can transform to one of (nearly) normal and healthy weight. But I harbor a dark passenger inside me that triggers me to binge eat and eat to the point of sickness. Do I consider that to be a personal failing and sign of weakness? Yes, yes I do. That’s the bias I bring against myself. Are there genetic factors that predispose me to these behaviors, I’m sure there are. In the end I feel like it’s up to me, and to my patients, to overcome what genetic factors we may have. And the good news is that if diet and exercise alone don’t help enough, there are medications and surgery that can. I want myself and my patients to feel healthy, strong, and capable. Being fat doesn’t make me a worse person, but it does make me less capable of living a long, full, healthy, and active life. So I won’t sign off on fat acceptance; I won’t normalize obesity. I will keep doing everything in my power to help myself and every one of my patients live our best, healthiest lives.

The Pay Gap- a Rude Reminder of it’s Existence Courtesy of a Sexist Doc

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As we were all so rudely were reminded today, by the now infamous sexist Dr. Gary Tigges, a pay gap exists in medicine just like in all other fields. Looking back on the history of medicine, and of the world, it’s not hard to see how we got there.
Medicine, like any other scholarly pursuit, was dominated by men for several hundred years. Modern medicine, in the 21st century, saw the spread of medical schools and the numbers of licensed physicians increase dramatically. Women lagged behind men for decades and decades, until just the last few years. In the US, the majority of people entering medical school are now women. We will continue to outpace men in the coming years.
So why is there still a pay gap? Just like in other fields, the answer is complex. It starts with the fact that women historically have entered lower paying specialties like pediatrics, family practice, and psychiatry. Men have domineered the specialties that pay higher- namely any specialty where procedures and surgeries are performed. Women have faced discrimination getting into these surgical and more lucrative specialties for years, thus amplifying the pay gap, and are only now in the last 5-10 years breaking into them in record numbers.
Even when women get into the specialty of their choice, they still make on average 27% less than their male counterparts (source Doximity survey), which amounts to over $100,000 less per year. The usual reasons apply here: being punished for taking time off to have children, being seen as less dedicated to their jobs, having to call off due to childcare or family emergencies, women who negotiate for higher salaries are viewed as abrasive or demanding, etc.
So how can we end the gender pay gap in medicine?
1. Compensate non-surgical specialties with higher wages. Medicine has become a culture where “pay for procedures” has dominated for years. Let’s value traditional medicine by increasing pay for those who practice the bread and butter of patients’ care.
2. Salary transparency. Contracts for payment are so cloaked in mystery that we often don’t know how much our colleagues make. It is frowned upon to discuss salary, which only allows men to continue to earn more.
3. Encourage, don’t dissuade women from negotiating. Offer other benefits than salary- like flexible scheduling or extra vacation days to incentive women.
4. Don’t apologize for our success or undervalue our worth. Own your accomplishments! Get rid of “I’m sorry” syndrome of perpetually apologizing.
5. Finally make paid family leave a reality!!!!! It is a stain on our country that we have not enacted this in the year 2018.
6. Imbed affordable childcare into all our hospitals and doctors office. Childcare is often expensive and can be unreliable, let’s make it a no-brainer by having it available in the workplace.
And last- but most importantly- speak up and speak out! Don’t let your voice be silenced and use your vote to elect candidates who prioritize closing the wage gap!

What does it feel like to be fat?

When you are fat, what does it feel like? It mostly feels like you are nothing. Like you are invisible and disposable. People look right through you. They bump into you and don’t apologize. To them, you don’t exist, you don’t matter. Until the moment your fatness affects them, and then you do.
Seated next to me on the airplane? Yes, thank you, I see your constant fidgeting. I know my thigh is pressing against your leg. I am clenching my arms to my sides to try and give you more room, but I know I am invading your space. I saw you glare at me as I sat down and moved the seatbelt to its longest setting. I heard your sigh when I asked to get up and put my bag in the overhead. And guess what? You and all the other passengers saw me struggle to lift the heavy bag, but no one- no one- offered to help me. You dart out of your seat before the seatbelt sign was even off, like you were going to catch my fatness like a disease if you stay one second more next to me.
Watching me walk through the gym? You pretend to be in your bubble on the elliptical with your headphones, but don’t worry I see the disgusted look you shoot my way. I have been going for only ten minutes at a snail’s pace, but am drenched in sweat, it’s dripping all over everything. I get off the machine and wipe it down with the sanitizer. I see you waiting for it and I see you armed with your own paper towels and soap, ready to remove the filth of the fat girl’s sweat. Moving through the weight machines I may as well be a ghost, unless I am taking up valuable real estate at the machine you want. I heard you and your six-packed friends asking why I even bothered. I heard you.
Parked your beach blanket next to mine? I see you look at me and my husband. No we don’t have kids. It’s just us. I didn’t get fat gestating the next generation, I just am. I did this to myself. I picked a run of the mill one- piece; splurging on underwire so my boobs don’t hit my knees. I see you visibly wince as I rub lotion on my skin and walk to the water’s edge. You sit there smoking and throwing your beer cans on the sand, yet you think you are better than me solely based on my appearance. My fatness means I am a lazy, stupid, likely poor and uneducated person. You couldn’t care less, I mean nothing to you. If I told you I am a doctor, you would laugh in my face. It’s incomprehensible to you I am anything other than a fat, worthless woman.

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