A Helping Hand

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“You HAVE to tell all your patients about this! It’s the BEST gadget I’ve ever tried – and believe me, I’ve tried dozens!” said my patient as she pulled this out of her purse the minute I walked into the exam room. She’s not a representative of the company in any way. In fact, the brand isn’t anywhere on the gadget. It’s a 6-in-1 tool that can open soda cans, bags, bottles, jars. Anyway, if you can find it, my patient says to snap it up (and wanted me to spread the word on the blog).

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Walking for Arthritis

The Arthritis Foundation holds fundraising walks all across the country. This year’s Central Massachusetts walk will take place on Sunday, September 11th. Please visit the website for more information.

The Arthritis Walk® is the signature fundraiser for the Arthritis Foundation. It’s not just an event,
it’s a celebration of year-round movement to help prevent and treat arthritis.

Every year we get together to celebrate movement and make a positive impact on the lives of people living with arthritis by raising funds for
arthritis research, education and life improvement programs in 250 communities
across the country.

Participants walk in honor of a friend or family
member with arthritis. People with arthritis wear blue hats to signify their
action in taking control of their condition. The event features a three-
mile and one-mile course
, with arthritis information and activities for
the entire family. In many communities, pet owners are invited to bring their
dogs along for the event.

Our rallying cry, Let’s Move
Together®
encourages people to get up and get
moving. When you join us at the Arthritis Walk®,
you’re not moving alone-you are becoming part of a community looking to achieve
better health and change lives at the same time. We hope to see you
there!

For questions about the Central Massachusetts
Arthritis Walk, or help fundraising please contact Margaret at
mfarmer@arthritis.org or 617-219-8228

What’s in a name?

This post doesn’t have much to do with medicine, but some coworkers and I were recently discussing whether a person’s age could be guessed by looking at his or her name. Admittedly this works better with women’s names. I guess men have more timeless names. There are a few names that fall into the “could be 2, could be 90” category of old names that are new again, such as Lucy and Grace. I haven’t seen any Britneys or Kaleighs about to appear on TV for a “Happy 100th” acknowledgement.

However, we came up with a list of names that, well, aren’t old and aren’t young. I bet you could guess that ladies with these names fall somewhere around halfway to 100:

Cynthia/Cindy/Sandy

Linda

Diane

Susan

Joan or Joanie

Carol

Barbara

Marilyn

A couple of grade-school teachers confirmed there aren’t many, or even any, little girls coming through with the above names. How about men’s names? I can’t really think of any. Maybe Steve. Or Richard.

There’s actually a government website where you can type in a name and it will tell you over whatever period of time you select the popularity of a given name. I guess this post is personal as my own name (Julie) was 10th about 40 years ago and is now 389th! Nope, no Julies these days. Add that to my list above.

It’s a man’s world?

When I was a medical student, now over a decade ago, we had a fairly active “women in medicine” chapter, despite the fact that our class was at least 50%female. Understandably, the whole work-life balance debate was a main topic of discussion, although thanks to the recent uproar over part-time docs, that issue is forefront again. At any rate, one thing I remember from these gatherings is a statement made by an upper level resident offering her worldly advice to us impressionable young medical students.

“I watch Sports Center with my boyfriend every night,” she said. “That way I have something to contribute to conversations with the guys while we’re in the OR.”

Consider the opposite scenario – a group of male medical students getting together for support, being told to read In Style magazine or watch a reality TV dating show so they’d have something to talk to their female colleagues about (I know, gender stereotypes abound).

The question arose back then – do we, as female medical students and residents have to play in a man’s world to get ahead? And is it over when we’re attendings?Are we still excluded from the clubhouse?

A few months ago I attended a local medical society women’s group where we explored the very same questions. We discussed how women tend to emphasize group collaboration over individual achievement. When given a compliment, many women will deflect or minimize the praise. Does this partially explain the reason women physicians are paid less than their male counterparts? Through role playing exercises, we learned how to craft PAR (problem, action, results) statements and borrowed other concepts from the business world, such as having a ready-to-go elevator speech about your accomplishments in the event you meet an important contact. I have to admit, I do like knowing that I have a way to communicate my current projects to the CEO or a colleague from another institution when I run into him or her at a meeting.

However, a lot of these changes are conversation styles or body language typically attributed to men. Someone raised the point I had been wondering years ago, “Do we really need to try to act more like men to get ahead?”

Sorry, new medical students and residents, I have no conclusions for you today. Concentrate on learning as much as you can and caring for your patients. Be confident. Be assertive when you need to. Respect each and every member of the healthcare team. The vast majority of your patients won’t care if you’re a male doctor or a female doctor. They just want a good doctor. Happy July 1st – happy medical new year – and good luck!

Foodie Friday: mushroom farm

Attending the Boston Flower and Garden show this year, I was taken with the idea of a grow-your-own mushroom kit that was on display. Well, the texture of the final product was chalky and dry and not something I wanted to eat. However, the process was interesting and might be fun for a kids’ project. Here are some photos over a few weeks’ time.

Do you need a cortisone shot?

I presented this article at our recent Rheumatology journal club: “Exercise therapy after corticosteroid injection for moderate to severe shoulder pain: large pragmatic randomised trial” from BMJ (2010).

It is available full text via the link above. In a nutshell, this was a study of 232 people over 40 with unilateral shoulder pain. People with prior  surgery or underlying conditions such as prior surgery or known arthritic conditions like RA were excluded (along with several other exclusion criteria). Patients were randomized into steroid injection (20mg triamcinolone) AND physical therapy or physical therapy only. Response was assessed at weeks 1, 6, 12 and 24. From the article text:

What is already known on this topic

  • Shoulder pain is common, persistent, and often caused by subacromial impingement syndrome

  • Exercise, manual therapy, and corticosteroid injections are common interventions in primary care for this condition

What this study adds

  • Steroid injection combined with exercise is of similar effectiveness to exercise only at 12 weeks

  • A third of patients treated with exercise and manual therapy alone do not improve sufficiently by 12 weeks and will opt for a steroid injection

  • Earlier improvement in pain and function is seen with corticosteroid injection combined with exercise and manual therapy

Will this change how patients with shoulder pain are treated? Probably not, but it is reinforcement of what we do typically see in practice – shoulder pain usually improves by 3 months whether you get a steroid shot or do PT, but it will improve faster with an injection. However, there are complications to injections so if patients are nervous about that, needle phobic or just willing to do a course of PT then there certainly is not a need to absolutely do an injection. There was no arm of people who JUST did an injection and didn’t do PT (which is probably the more likely scenario for people who get injections) and I’d like to know how they compared with the other groups. Thoughts?

Sick of the part-time debate yet?

There’s been a lot of fallout over this weekend’s New York Times Op-Ed piece about doctors, particularly female doctors, working part time. I enjoyed reading the multiple reactions and reader comments and have been thinking about it quite a bit over the past few days. On my recent half day off I joined one of my partners at a conference reviewing Rheumatology board questions with the residents. Afterwards, since I was close to the office, I stopped by to sign some papers, review labs and make a few follow up calls.

Walking in, my partner says, “Hey, what are you doing here? Isn’t this your day off?”

Me: “Yeah, well, haven’t you heard? I’m ruining medicine with this part time nonsense!”

What exactly is part-time? In this world of “widget” medicine where we’re only paid for patients seen face-to-face in the office, we need to assign a value to the hours of uncompensated time outside normal office hours. Indeed, my “time off” is often spent attending meetings, participating in teaching sessions, reviewing research projects, filling out patient forms, catching up on labs, phone calls and emails and coordinating care for patients with difficult or complex cases. Things I maybe didn’t have a chance to do or couldn’t do before the office opens at 8am or after the doors close for the day. Fortunately or unfortunately, the fact that I can access my EMR from my laptop means I’m (and probably a lot of other “part-timers” are) never really away from work.

Is it easier to work a full-time schedule in more of a shift-based specialty like anesthesia, hospital medicine or EM where there seem to be less demands outside of one’s actual on-site work? I certainly don’t want to speak for my colleagues in primary care, as I know my office paperwork burden is a fraction of theirs. However, until there is less bureaucracy in medicine, compensation for time spent in non-contact care coordination and, yes, malpractice reform, physicians (male and female) will continue to seek part-time work or explore other practice environments. I applaud those who have made this lifestyle choice, whether to spend more time with kids, write a book (or blog) or pursue other interests related or not related to medicine. Thanks to those who have echoed Dr. Centor’s assertion that he would rather see a committed part-time doc than a full-time doc who is burned out.

Here are some links to related articles:

Dr. Centor – medrants.com

Dr.Jen

WSJ Blog

KevinMD

Dr. Au’s response

NYT parenting blog