We really do have a problem

“Wisdom comes only when you stop looking for it and start living the life the Creator intended for you. “

Hopi

“I refuse to accept the view that mankind is so tragically bound to the starless midnight of racism and war that the bright daybreak of peace and brotherhood can never become a reality… I believe that unarmed truth and unconditional love will have the final word.”

Dr. Martin Luther King

 

My grandparents were often described decent people. The definition: “conforming to generally accepted standards of respectable or moral behavior” is a fitting description of them. They were not perfect but to me they were.  Many times, we would often wish a spanking from my grandmother rather than what my uncles called one of her “sermonettes. Her father, my great-grandfather was a Baptist Minister. She could quote the Bible from memory. When we even mentioned being bored, she handed us the Bible, the dictionary or the Encyclopedia and expected us to read it.. My grandmother was our childcare provider while our parents worked. These sermonettes required us to listen as she called upon us to be decent and caring people.  She wanted us to be better than those around us. She required us to be in church on Sunday mornings and with one look put a stop to any misbehaving. The “Golden Rule” was an essential theme in many of those sermonettes.  To paraphrase, “Do to and say about others what you would have done to and said about you.” My grandfather was just a gentle giant.  Kind, loving and respected by everyone.

I took those lessons to college and to Medical School and it influenced how I cared for my patients. From the first day of my internship, it became apparent that not everyone learned how to be decent.  I had to work hard to do all my notes. One attending critiqued each one to make sure they were grammatically correct and accurate. I went in to admit a patient and she kindly asked me to leave.  I was black and she was obviously a very wealthy white female.  Interns did the admitting history and physical on all admissions on the teaching service. I was happy to be sent away.  It meant I could leave early right after our  sign-out.  Well much to my dismay, I was summoned back to the nurse’s station and told to go back in and do the admission. It seems that my attending had told the patient that if she wanted to stay in the hospital she must be admitted by me, Dr. Washington, the Black female intern. The patient looked at me and said” It looks like you and I  are going to have to work together.” I ended up leaving late but I left with a sense of accomplishment.  I was fortunate enough to hear a story marked with pain, suffering and disappointment.  I paid her the respect I was taught to give to all patients and she responded.

It is obvious that more people should have had the benefit of listening to my grandmother and being in the presence of my grandfather. She has been gone from my life for over 10 years but I still carry the imprint of her love and guidance.

Racism, sexism, and fear  are impacting every aspect of our lives. In medicine, it is impacting the diversity of our workforce and increasing health disparities.  As we recognize the life of Dr. Martin Luther King, we see the erosion of the very values he stressed in his sermons and in his life. I often reread some of those sermons to gather inspiration. The January issue of the Society for Teachers of Family Medicine Journal is dedicated to looking at the issue of racism and highlighting departments that are addressing this complex problem.  From the Editor:

“We must create spaces that are more inclusive and recognize our unconscious biases. We need to commit to fighting injustice in health care and ensuring families can live well to the best of their ability. The real work to make this a reality will have to occur in every single medical practice and training program in the nation.”

Bich-May Nguyen, MD, MPH

https://journals.stfm.org/familymedicine/2019/january/

 “There comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must take it because conscience tells him it is right.” 

Dr. Martin Luther King

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Good-bye 2018! Hello 2019!!

Hope smiles from the threshold of the year to come, whispering, ‘It will be happier.’Alfred Lord Tennyson

2018 was both exhilarating and unsettling; with happy and sad moments. For me, it started with stress induced hair loss. I noticed it as we were preparing for a major electronic health record implementation. I volunteered to take a lead role in the implementation for our program. I panicked when I finally noticed the patch of thinning. I called my stylist looking for help and she calmly explained to me my options. She explained why crocheting was a better option than braiding, weaving or just having a very low cut natural style. I decided to go with crocheting. It has given me a new carefree look. Thankfully, my hair has grown back but I love this look and plan to keep it for a while.

I have spent 35 years taking care of patients bit you are never prepared  to confront medical problems in you families. After finding the best solution to my problem, I was hit with my mother’s sadness over not only the loss of her sister (the oldest) but also her diagnosis of breast cancer. Her sister had a stroke that would have left her debilitated but my cousins chose hospice care. She went peacefully after her sisters’ visit. My mother sailed through the bilateral mastectomy  We talk almost every day and but she still misses her sister. I could not make it to the funeral and my sisters were there to help her because I was studying for my Family Medicine Recertification Exam. The test was on Friday, April 13.  Not to brag but I passed with a higher score than I did 10 years ago.

In July, we went to the Arrington-Giddens Family Reunion in Chicago. It was so inspiring to see how the Chicago side of our family prospered after my grand aunt fled the racism of Birmingham and along with her brothers who followed built a rich life on the Southside of Chicago. The tour of the area was educational an included the homes Mohammad Ali, Louis Farrakhan, and the Obamas. Shout out to Michelle Obama for the top-selling book of 2019. The book beautifully showed life on the Southside of Chicago and the southern roots of families as they started new lives during the Northern Migration.

In August, we traveled to Birmingham to see my mother. I didn’t have time to visit all my old friends. We did go to church on that Sunday.  I was fortunate enough to wish my second grade teacher farewell because she is over 90 and transitioning from her long life of independence to live with her son in Texas.  I was overcome with both joy and sadness to see someone who once towered over me weakened by age. She was one of the architects of my success along with my mother.

In September, I realized that the love of my life had a terrible shoulder problem. Fortunately with physical therapy, we were able to celebrate his 75th birthday December 1st. I am now on the other side of 60. It seems like yesterday we celebrated his 40th birthday. Now it really is thirty-five years together. So, now it has been thirty-five Christmases and New Year’s spent together.

Politically, this year has been both disappointing and inspiring. The November election led the way for the most diverse group of legislators in our history  and the Mueller investigation were two positives.  The appointment of the most recent SCJ was a disappointment but many rulings by our circuit court judges have protected the rule of law. The fight over the Border Wall, immigration, and the separation of families was not our best moments.

2018 was also my year to embrace my meditation and yoga practice which formed the foundation for my positivity. I am going to rededicate myself to my yoga and meditation practice in 2019.

Here’s to 2019. I am ready to face it head on.  Happy New Year!!!

Your success and happiness lies in you. Resolve to keep happy, and your joy and you shall form an invincible host against difficulties. Helen Keller

 

Mi Gente

Quote

To inspire the next generation of underrepresented in medicine (URM) educators, the STFM Foundation is launching a year-long blog series. In the new series, The Path We Took, URM members will share the path they took to become faculty and leaders in family medicine. This post was written by Edgar Figueroa, MD, MPH

via Mi Gente

One African American Woman’s Leadership Journey

STFM Blog

Judy Washington, MD Judy Washington, MD

To inspire the next generation of underrepresented in medicine (URM) educators, the STFM Foundation is launching a year-long blog series. In the new series, The Path We Took, URM members will share the path they took to become faculty and leaders in family medicine. I’m delighted to kick off the series by sharing my own leadership journey.

One African American Woman’s Leadership Journey

When you have the privilege to serve in leadership, you have the responsibility to reach back and identify other colleagues who would not otherwise have the opportunity to be recognized. You can do this through mentoring, building systems to support the underrepresented, or financially supporting the individuals or the systems that assist them.

When the opportunity was presented to be a cochair of the Minority and Multicultural Health Collaborative, I said “Yes!”  I was fortunate to work with two wonderful African American women…

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One of Those Kids in That Class Is Me and They Deserve a Chance

STFM Blog

Crichlow_R_2015 Renee Crichlow, MD

In the last couple of years, I have been a co-teacher in an undergrad program part of whose mission is to increase underrepresented in medicine (URM) students in our medical school. There are many reasons I have chosen to do this and to fully understand, I thought it would be important to share a little bit of my student career history.

To begin, nothing in here is about bragging. It’s really about sharing a story that may be similar to what others have seen.

My high school was a very high performing public school: we had 13 National Merit Scholars in the year I graduated, and I was one of them. (Except at that time in 1985 my award was called National Merit Outstanding Negro Scholar. I’m not joking. That’s exactly what it was called in 1985.) I mention this because it’s an indication of the fact…

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Happy Father’s Day

I have been fortunate to have experienced the effect  loving fathers  have on the lives of their families, friends and colleagues. My grandfather was the ideal father.  He was always so loving and caring.  He never raised his voice but when he did it was well deserved. He provided for 10 children and scores of grandchildren, great-grandchildren, nieces, nephews, friends and everyone else who found themselves in our extended family.  We called him “Big Daddy.” To others, he was Mr. John, Uncle John and Mr. Waldrop.  I cannot forget my uncles who were my mother’s brothers and her sister’s husbands. They cared for all of us like we were their own children.  My parents were divorced when I was five years-old so they all filled the void.

The others were patients I have cared for over the years.  So many of them I met because their wives pushed them in to the office.  When they finally got there, they often shared why they were so reluctant to come. Many thought I was just this kid and I had to win their respect with my skill. Once accomplished, they came in and confided in me.

They appeared to be healthy hard-working husbands and fathers. Unfortunately, I diagnosed quite a few with untreated hypertension, cancer and diabetes. It can be the hardest thing a man does when he admits he has an illness.  I found what I thought was just a cyst on a patient’s back.  It turned out to be metastatic kidney cancer.  He was so strong through the ordeal.  Most concerned about his wonderful wife and his children.  His wife was my patient. It was not a prolonged illness and he did not have a  long battle.  We did not have many treatment options.

My favorite couple was one of my most tragic cases. Mr. C ‘s wife had multiple medical problems. Through it all he was there. She developed a blood clot in her leg and then we finally diagnosed cancer of the kidney. We transferred her to the University Hospital but she died during surgery. He was devastated.  Every visit was not about his medical problems but about the loss of his wife, soul mate after more than thirty years of being together.  He was comfortable enough after all this time to reveal how lost he felt. He was overwhelmed by the advances from women who wanted to take his wife’s place.  He was surprised because many of them were her friends.  I tried to be helpful and not offend him. I told him he was such a good husband that they wanted to have the same loving relationship. He was not ready.  I found myself giving him tips on how to handle those lovely church ladies many of whom I knew because they were patients or I knew them through my work in the community. He would just say “She was a beautiful woman and no one can replace her.”

One of my colleagues, Dr. S, entrusted the care of his beloved wife to me. It was a compliment but I felt I had failed the first time I admitted her to the hospital. I soon learned that he had been taking IV bags on vacations just in case she had a problem. She had decided he needed support. She was devoted to him. She would tell me stories of the old days when doctors lived in the hospital housing.  She was a nurse and that is how they met.  She held the family together while he was always in the operating room.  They lived on what she earned because residents had meager salaries at that time. He was the beloved surgeon. She had managed his office and his life. When she died, I remember telling him to take care of himself.  He had retired.  His daughter-in-law hugged him and said that was her responsibility now and she was honored to do it.  He had been there for everyone.  I did respect his philosophy; he was going to use all the money he made to enjoy time with his wife.  He planned to leave no money for his children and they knew that.  However, he left them more, the legacy of his hard work and total devotion to them.

We always think the smoker will get lung cancer. Sometimes, it is the innocent one who spent all those years saying, “Please stop smoking.” Finding out that the lung mass in the non-smoking wife is cancer can be devastating to the family.  When that cancer is one typically associated with second-hand smoke exposure, it is especially hard.  I had cared for the wife and my male colleague, her husband. She died from her cancer. He had to go on and struggle through her loss and unfortunately, emphysema. His daughters took care of him because he was a loving father and husband who made sure they all had the best.

Father’s Day is a time to honor those men who love and support their families. I remember admitting a dad who had developed pertussis (whooping cough). The pediatrician admitted the infant daughter.  He was so upset that he had been the one to make his child sick.  We explained this can happen

Loving husbands and fathers make a difference. My husband has cared so lovingly for his children. He spent many hours taking our son to the Pediatrician alone for shots.  It was difficult for me to get away from my training and later the office.  He did the soccer games, tennis lessons and all the homework.  He was the Book Fair volunteer; he and another Dad would make sure the kids made smart book choices.  He was the chaperone on the school trips. He made all the visits to the orthodontist for the braces, found the Barber for the haircuts and scheduled the music lessons.  He cooked all our meals and even did the laundry.   He also just made sure I was always safe and loved as I navigated my professional career.  He made some sacrifices that made it possible for me to focus on my career goals.

Happy Father’s Day!!!!

Yes, Medicine too

“Many white Americans of good will have never connected bigotry with economic exploitation. They have deplored prejudice but tolerated or ignored economic injustice”. Dr. Martin Luther King Jr, Why we can’t Wait, 1964

My mother worked two jobs to support the three of us. She did refuse to clean houses.  That was not where she saw herself day in and day out.  She landed a job in an upscale boutique in a wealthy section of Birmingham.

I learned early in my life about racism and sexism and how it can hold a family back. When I applied for summer jobs, they were always filled. The jobs in fast food restaurants that paid well went to white students and the openings in our community were filled.  So, I was a camp counselor for free, taught vacation bible school and did a summer science program.

I have never made a comparable salary to white male or female colleagues. As a minority or Underrepresented in Medicine (URM) physician, you are always negotiating a contract; you find out later that even when you asked for the higher salary, it is negotiated down to a lower salary.  You have a suspicion that the salary is low but you really want the position because it is the next logical step in your career. I remembering emailing back and forth with one department chairman furiously trying to get the salary higher only to he was just trying to save money.  I found out later, that he had offered a higher salary to the male and he turned it down because it was too low.  When I asked for a comparable salary to what I was making, he said he couldn’t meet that.  I wanted the position so I took it.  Every time, I got a new committee position or asked to head a committee, my husband would ask “Does that mean you get a raise?” My answer “No, just more work and late nights.”  I spent hours putting together reports, presentations, new curriculum and taking courses to increase my credentials.  I did get finally get merit pay and bonuses after the second year but there were later budget constraints and the end of the grant that paid my salary.  Such is the fate of many URM academic physicians.

I left one position and in asking me to say, my boss said, “I realized when you gave notice that I should have been paying you more for all the work you were doing.” I had tried for over a year to negotiate a bonus structure but she was resistant to the idea.  She even refused to negotiate a contract.  When I left, I was happy that I could leave without any contractual obligations.

My first job out of residency revealed that the hospital administrator knowing lowered the salary and my later partner knowing allowed me to be cheated. I took that knowledge and went on to build a successful practice by taking on contracts as a consultant to increase our practice revenue and my credentials.

Even in medicine, women but especially URM women are paid far less than their white male counterparts. I support the “Time’s up Now Movement.” In every place of employment in the US, we need to have an open review of job descriptions and salary compensation for men and women.

“Injustice anywhere is a threat to justice everywhere”. Letter from Birmingham City Jail, 1963

“Each time a [ woman] stands up for an ideal, or acts to improve the lot of others, or strikes out against injustice, [she] sends forth a tiny ripple of hope, and crossing each other from a million different centers of energy and daring those ripples build a current which can sweep down the mightiest walls of oppression and resistance.” ― Robert F. Kennedy

As we commemorate Martin Luther King Day, let’s recommit to fight racism and social injustice.

Happy New Year

I am so glad 2017 is coming to an end.  I hit the big 60 this year and that was a high point.  However, the low points cannot be overlooked.

Socially and politically, we witnessed outrage and disgust. Women marched on Washington.  The blatant assault on our rights was too much and women of all cultures and faiths banded together across the world to demonstrate in record numbers.  Black women in Alabama stood together and drowned out the overt racist, sexist and vulgar representation from one man and sent a powerful message across the world.  I had the pleasure of celebrating that victory with two friends  and my husband with dinner and  a bottle of the best champagne I have ever had.  But once again, I was appalled by the number of people who voted for this person.  It mirrored the horror of the presidential election but with poetic justice.  So, I do admit I am having a hard time talking with and listening to people who say they voted the way did to protect “Christian values”. Because, there was nothing Christian displayed.

On the right to vote, Dr. Martin Luther King said:

“Voting is the foundation stone for political action.”

The unspeakable acts committed against women in the workplace was especially upsetting.  This behavior highlighted the lack of diversity, the abuse of power and the ineffectiveness of the present training.   However, despite what we have heard,  there are still so many other stories out there to be told. So many of these incidents happen daily in workplaces in small towns and in immigrant communities.  Women forced to survive and care for themselves and their children are victims.  In doctors’ exams rooms, women tell horrific stories, we listen and offer support.  We can’t force them to file complaints with Human resources or the police.  Many are scared because of their undocumented status.

Dr. King on silence:

” Our lives begin to end the day we become silent about things that matter.”

In healthcare, the defeat of the whatever that awful bill was to overturn the Affordable Care Act was a step but the erosion to that law is going to have major consequences. Many aspects are not being funded.   I am a medical educator. That means I am paid to mentor the next generation of primary care providers. Very few Americans understand how we pay for medical education in this country. Well, it is paid for by first the student who decided to go to medical school.  The average student completes medical school with over $200,000 worth of educational loans.  They enter residency training and then out to practice or into fellowships.  The need for primary care physicians is great and the number is growing too slowly.  The Graham Center has projected that in order to maintain current rates of utilization, New Jersey will need an additional 1,116 primary care physicians by 2030, a 17% increase compared to the state’s current (as of 2010) 6,236 PCP workforce.  Compared to the Kentucky, which will need an additional 624 primary care physicians by 2030, a 24% increase compared to the state’s current (as of 2010) 2,520 PCP workforce.  To achieve this, we will need an increase in dollars directed toward Graduate Medical Education and medical education debt relief. So, I hope you see why I am not cheering my tax savings because I and all of you are losing a whole lot.  The tax cuts will be “disastrous”.

The blatant attack on the Children’s Health Insurance Plan shows the lack of insight and compassion to understand the implications of not insuring children and protecting their families.  Many parents are forced to leave their jobs to care for children with chronic medical conditions or acute illnesses that require extended hospitalizations.  Parents need their children to be covered because they forfeit the insurance once provided by their employers.  If the other parent picks up the cost of providing that benefit, then the cost is much higher.  In our office, we see daily the benefit of children getting Medicaid.  Newborns are covered from the moment they are born. Both inpatient and outpatient care is provided.  The immunizations are covered.  The other assault is on Federally Qualified Community Health Centers.  They provide the care in communities across the country that are underserved by primary care physicians.  Care is based on income and they provide care to Medicaid and underinsured patients.  The number of these FQHC’s were expanded under George Bush’s administration. Physicians in these FQHC’s are often recipients of loan assistance through the National Health Service Scholarship program.  The funds for this program are included in the Affordable Care Act.

Despite all of this, I do remain hopeful.  If the success of the vote in Alabama teaches us anything, it does show the power of voting and we should never sit home again and feel that our one vote does not count.  It does and it can change the world.

Martin Luther King quotes for the New Year:

 

“The whirlwinds of revolt will continue to shake the foundations of our nation until the bright day of justice emerges.”

 “With patient and firm determination we will press on until every valley of despair is exalted to new peaks of hope, until every mountain of pride and irrationality is made low by the leveling process of humility and compassion; until the rough places of injustice are transformed into a smooth plane of equality of opportunity; and until the crooked places of prejudice are transformed by the straightening process of bright-eyed wisdom.”