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.

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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.”

Vacations are important

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Definitions of vacation include ” a period spent away from home or business in travel or recreation”  I just had a long vacation.  It started on a Friday a and ended on a Wednesday 12 days later.  I a great deal of my time being asked and answering questions for my patients, residents, staff and administrators. I think vacations are important. I think I waited too long to take this one. I had so many tasks to complete to end one academic year and start a new one.  Research day completed, new rotations updated and arranged and lectures planned.  Also starting our new resiliency curriculum.  Last year at this time, I was starting a yoga instructor training program.  I completed it in December.

It started with delayed flights on Friday.  Finally arriving in Puerto Rico.  I had a brief rest after getting to the hotel at 5 am on Saturday.  We had a beautiful walk on the nearby public beach (all the beaches in PR are public).

Then a  tour of Old San Juan.  I am ashamed to say this was my first visit but it will not be my last one.  We had traditional food at Raices Restaurant in Old San Juan.  It was so good we went back on Sunday.

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We boarded our Carnival Cruise ship, the Fascination.  We were off to celebrate my stepdaughter’s 40th birthday.  I started the cruise with a long massage. It set the tone for what would be a very relaxing vacation.  We embarked to our first destination.

 

 

St. Thomas was sunny and beautiful.

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View of ship docked in St. Thomas

After a rainy day at see, we were rained out in Barbados and St. Lucia.  We did brave the rain but ended up getting a ride back to the ship.

St. Kitts was sunny and we did the Island tour.

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We spent the last day in beautiful St. Maarten

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We ended up back in Old San Juan with a tour of Bacardi.  It was living history through the story of rum.

I will not wait so long for another vacation.  I hope to stay connected to this sweet feeling of relaxation and calm. The best part of the trip was spending it with the ones you love.

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The War on Drugs or Not?

I try to reinforce to my doctors in training the importance of getting a social history from their patients.  Where do they work, what are they job responsibilities, where they live, do they drive and of course family connection?  This also includes a sexual and history.  The last is the substance abuse history.  More and more, patients are admitting to use of marijuana which doesn’t surprise me.  The opioid pain-killer and heroin use is hidden from us when we ask but we have to start pushing to get the answer.   We have to be more comfortable discussing opioid misuse and abuse with our patients.

I have found that our Black and Latino population does not use drugs in the numbers we would think.  The myth of their increased use had been perpetuated in the news media until recently. We have a large Latino population in our practice.  Most of our Black and Latino female patients do not smoke drink much less use drug.  Our Caucasian patients are more likely to be smoking marijuana, drinking socially, using opioid pain killers and heroin.  That is a fact that is now just being openly discussed and represented in the news media.  This graph shows the shift.  You would be wrong to think this represents more Non-Hispanic whites seeking help than Non-Hispanic blacks.  It clearly shows the dramatic increase in the number of addicted white patientsOpioid Stats

I was a medical student and a resident during the devastation of the Black community from drug addiction and AIDS and the cruelty of the “War on Drugs.” We asked for more drug treatment and needle exchange programs.  We got more prisons, harsher jail sentences and cutting of funding for treatment.  Now the face of the addiction epidemic has morphed from the Crack Cocaine addicted black face to the Opioid Addicted white face with an epidemic proportion of overdoses and deaths.  No jail time.  I remember that tragic scene from “Lady Sings the Blues” as Billy Holiday (Diana Ross) is locked up and withdrawing in such pain and agony.  Congress has the opportunity to right a terrible wrong by increasing the funding for the Opioid epidemic.  That will not erase the harm done to our community but it will finally acknowledge that addiction is a medical problem. The psychosocial problems that Americans face and are now leading to lack of hope must also be addressed.

Death rates

The other issues in the Health Bill such as keeping funding for Planned Parenthood, keeping the mandate for coverage of contraception and maternity care are crucial to the health of women. White females are dying at higher rates from opioid overdoses.  Their rate is higher than that of Black and Latino women.  White males now have the highest rate at present.  Drug use among white suburban teenagers is increasing while it is decreasing in Black and Latino teens.  These are just the facts.

Some part of me is angry that the Black community had to suffer such devastation without much help.  Black and Latino teens will always be arrested and serve time for drugs.  They can’t get into medical or law school. They are limited in their career choices. Now whites, are still less likely to serve time because their parents call for treatment and less strict drug enforcement is being heard.

I started reading The New Jim Crow: Mass Incarceration in the Age of Colorblindness by legal scholar Michelle Alexander. I had to put it down because it evoked such emotion.  All the people in the on-line book group I was in had the same feelings. “Black people comprise just 13 percent of the U.S. population and use drugs at a similar rate as other racial and ethnic groups – but they comprise 29 percent of those arrested for drug law violations and roughly 35 percent of those incarcerated in state prison for drug possession only.”  These are the facts.  Until we as a country address this issue, we cannot move forward in the treatment of addiction as a medical not legal problem.

It is compassionate care but if we punish one group and have leniency with the other it is not justice and medical care is not provided equally

 

 

Happy Father’s Day

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.  Back then it was a few cases and now there are more.

Loving husbands and fathers make a difference during difficult times. My husband spent many days 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 brace, found the Barber for the haircuts and scheduled the music lessons.  He cooked all our meals and even did the laundry.   He also was very involved with his children from his first marriage.  I met him a few years after the divorce.  After we started dating, I met his son and daughter when they were age 7 and 8.  I took the liberty of putting his daughter’s hair in a neater style.  She was so cute. We have celebrated 32 Father’s days together.  I think he still has many of the cards.

Two black male journalist and fathers look at the myth surrounding the absent Black father. Ta-nehesi Coates writes eloquently about this is his article Understanding Out-of-Wedlock Births in Black America He revisits the Moynihan report and sheds new light on the findings. Charles Blow sheds light on this subject in his article Black Dads Are Doing Best of All. 

Black fathers have been the victim of stereotypes of being absent and uninvolved.  The LA times in December 2013, published an article covering a report released by the National Center for Health Statistics.  The table highlights some important statistics.  The report was based on a federal survey that included more than 3,900 fathers between 2006 and 2010.

Fathers

So let’s just celebrate all fathers today.

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Why I love my Mother- Reason 2

“I try not to say too much and stay out of it but you know I will give my opinion.”

This is the basic philosophy of my mother and her sisters, my aunts. I think it was passed on by my grandmother.  Our Saturday check-ins always includes this great line “Now that I have talked about everybody, I will let you go.”  I have always looked forward to talking with her and catching up.  When I graduated college and went off to medical school, I knew I would never return to Birmingham to live.  So my mother kept me in touch with my family.  Back then, there were no cell phones so I had to wait until the rates were low and call nights and on weekends.

I want to let you know that my family is by no means perfect. We have recovered drug addicts, alcoholics, ex-prisoners along with doctor, lawyers, a judge, politicians, healthcare workers, steel workers, people in banking and ministers. I consider my mother and her sisters our family’s moral compasses.  So, when someone gets out of line, one of them will try to set you back on the right path.  One of my relatives was not in the mood to have my mother interfere.  So he told her to “shut-up and mind her own business.” When she called to relate the story, I told her he was right.  I had just finished reading one of my many self-help books and I told her about “the art of allowing” In essence, it is allowing people to be themselves.  She was not about hearing that.  In her mind that is not an option. I did tell her to stay out of it because I did not want her to get hurt. She is such a loving person.  She said she was not going to let him mess up his life with letting him know she cared. When she told my aunts what I had said, to my surprise, they agreed with me.

I have learned from them that it is important to standup for what is right and not be afraid to voice your opinion. You have to try to keep others from harming themselves and if you can’t then be there to help them get back on their feet.  They are there for each other with love.  For us, they always have love and good advice.

“[My mother] had handed down respect for the possibilities—and the will to grasp them.” – Alice Walker

“Grown don’t mean nothing to a mother. A child is a child. They get bigger, older, but grown. In my heart it don’t mean a thing.” – Toni Morrison

Why I love my Mother- Reason 1

MomaThis is one of my favorite pictures.

This is a pre-Mother’s Day shout out to my mother. I think my mother and her sisters are the embodiment of “Loving kindness.”  My mother called for her usual Saturday check-in and recount of all the family news.  She updated me on my uncle’s fight with lung cancer and her new job.  At age 79, she has decided to work 5 hours a day.  She said she just wants to get out of the house. She has been caring for people since I was born.  She was the primary caregiver and health proxy for my grandparents, church members and my late stepfather.  We always laugh and end the call but this time, the conversation shifted to the embattled ex-governor of Alabama.  Of course, we all should know about the scandal and his resignation.  Alabama has a long history of governors who have not shown love and kindness for African Americans.  So, to my surprise, she said “Have you heard about our governor? Don’t you feel sorry for him?”  Well, my initial response was to smile and remain silent.  I wanted to hear what she had to say.  And once again, “loving kindness “and “judge not lest you be judged” was on full display.

She said” I feel so sorry for him. He has lost everything.  I think he meant well.”   I smiled and listened.

“His wife left him and his children are refusing to talk to him. He moved out of the Governor’s Mansion today.  There were only two men and a pick-up truck helping him.”  If anyone else had said this, I would have been laughing out loud. Yet, I listened to my mother and smiled.  As I heard these remarks, I flashed back to all the hate that has defined the political seen in Alabama.  Yet, at 79, that is not what she is focusing on.  She always encouraged us to be decent, loving and respectful.  My grandmother always said ‘if you can’t find anything good to say then just keep quiet.” I found myself reflecting on this and just not saying anything but “I guess you are right.”

I had the honor of participating in a five-series program sponsored by my hospital. We had two hospital chaplains who are Buddhist monks lead us in resiliency and transformation sessions.  The sessions focused on contemplative medicine through refection and meditation. I do find myself really listening to my patients, residents, friends and family members better.  It is caused being present. In his TED talk Julian Treasure talked about “conscious listening”.  You can use this acronym to help you listen and communicate better. RASA stands for “Receive,” which means pay attention to the person; “Appreciate,” making little noises like “hmm,” “oh,” “OK”; “Summarize” — the word “so” is very important in communication; and “Ask,” ask questions afterwards. So, I use this as much as possible to be a better listener.

So, I love my mother because she always reminds me to be a better person by displaying all the attributes I need to accomplish this. I even found myself feeling sympathy and empathy realizing that we all can make mistakes and one day will need someone to show us “loving kindness” and forgiveness

Biology and Chemistry got me into Medical School but the Arts made me a better doctor

I am an avid watcher of Public TV. My senior year in HS, my English teacher was such a brilliant man.  We were reading Shakespeare’s plays.  One assignment was King Lear.  I so enjoyed the play but it came to life for me when the PBS Great Performances series aired the play with James Earl Jones as King Lear, Ellen Holly as Reagan, Rosalind Cash as Goneril and as Cordelia.  It was my first to experience an all-Black cast performing Shakespeare.  I was mesmerized.  PBS has provided many memorable experiences for me such as Dance in America: Martha Graham Dance Company, Brideshead Revisited, and The Six Wives of Henry VIII.   I watched Upstairs, Downstairs and even Poldark I. Who could forget How Green Was My Valley and Madame Bovary?

Public TV has always been part of my life. I watched those early cooking shows with Julia Childs.  What is there for a girl growing up in the South who loved to read books to do?  I was a Premed major in college but after my sophomore year, I changed my major and minored in English.  I took a course in Shakespeare, English Romanticism, Chaucer and Southern Literature.  I was rejuvenated by writing and just reading.  I needed the science to get into medical school but I needed the Arts to make me a better doctor.  The Arts fed my soul and helped me become more altruistic and empathetic.  PBS allowed me to see performances that I never would have had the opportunity to experience because we did not have the money.  In college, I saw plays and live performances that were once in a life-time.  I saw the Martha Graham, Alvin Ailey, and Paul Taylor Dance Companies.  The concerts included Roberta Flack and Randy Crawford.

My life was enriched by funds from the National Endowment for the Arts and I fear that if the funds are cut, other children will be deprived of their opportunity to have their lives enriched. In elementary school, we had trips to the Symphony and arts programs. I spent many hours at the Public Library during the summer.  The Library was our unofficial babysitter. The NEA was created by the US Congress in 1965. Roger L. Stevens was the first Chairperson appointed by Lyndon B. Johnson.  The National Endowment for the Humanities provides grants for high-quality humanities projects to cultural institutions such as museums, archives, libraries, colleges, universities, public television, and radio stations, and to individual scholars. It was created in 1965 under the National Foundation on the Arts and Humanities, which included the National Endowment for the Arts.  The programs I benefitted from in college were funded by the NEH.

I will continue to support PBS every opportunity I get. We buy our favorite shows and give during the Annual Fund drives.  I can’t imagine my life without it.  From Foyle’s War to Downton Abbey, I have been educated and entertained.  What would I do without all those Ken Burns’ documentaries and Henry Louis Gates?  Oh my, how could I live without Nature? After a long day of seeing patients, I get a great laugh from Father Brown and Death in Paradise.

We don’t need more warships, aircraft or a wall on the border. We need the arts to allow us to dream and enrich our lives.  A little girl from the South can go to college, medical school and finish her medical training while maintaining her love of the arts because with the remote in her hand and right in her living room on her TV set, she could see a world that she never would have had the time or money to see.  That is what we may lose if these funds are cut.

Meals on Wheels

This month marks the 45th anniversary of the Older Americans Act Nutrition Program has been the primary piece of federal legislation supporting social and nutrition services to Americans age 60 and older since 1965. We have to  protect the critical funding for the Meals on Wheels programs that are working tirelessly day in and day out to provide nearly 218 million meals, either at home or in group settings, to more than 2.4 million seniors each year.  OAA programs are vital for seniors who are at significant risk of hunger, isolation and losing their ability to live independently. Services provided include:

  • Home-delivered meals and meals served in group settings such as senior centers
  • Transportation
  • Personal care and homemaker support
  •  Caregiver assistance
  • Preventative health

Did you know 1 in 6 seniors struggles with hunger. Meals on Wheels can provide a senior meals for 1 year for about the same cost as 1 day in the hospital.

Nationally, Meals on Wheels serves more than 500,000 veterans each year. The OAA covers 35% of the total cost to provide nutritious meals, safety checks and friendly visits to more than 54,000 Seniors. Programs rely on contributions from state, local, private donations and other resources to cover the rest.

I have worked with seniors in three different states.  This program kept them in their home and out of the nursing home.  It also prevented hospitalization and malnutrition.  I remember admitting several seniors to the hospital for dehydration which was due to lack of food and support services. Instead of going to nursing homes they went home.  Medicaid is the major funding source for covering the cost of nursing home care. Meals on Wheels  decreases the rate of falls, which cost our nation $34 billion each year. When a senior falls, they have serious injury that leads to hospitalization, admission to a Rehabilitation Center and then too often to a nursing home.

Sign the petition by 3/31/2017

http://www.mealsonwheelsamerica.org/take-action/advocate/sign-our-petition-to-protect-meals-on-wheels