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Sexism and Sexualization of Women: East vs West

I really couldn’t help but feel saddened by three recent news stories about the continued attitudes that are so harmful to women. If these media reports are right, Japan’s leadership appears to be way off target, referring to women as baby machines and refusing to apologize for enslaving and raping ~200K women in World War II.

America has a more insidious version of sexism that can harm young minds – exposing children repeatedly to age-inappropriate sexually explicit images and ideas. As we expand our understanding of neuronal plasticity, it is becoming more and more clear that what we see and experience can imprint itself on our brains and literally change the way we think and feel. We spend a lot of time worrying about what we put in our bodies (e.g. avoiding trans fats, food chemicals, etc.) I wonder if we should think a little bit more critically about what we let into our minds?

Here’s what I’m talking about:

Japanese health minister says women are “birth-giving machines”

In a report in which the health minister explained how dangerous the low birth rate is for Japan’s economic future, he suggested that women are a rate limiting factor. There are only so many “birth-giving machines… and all we can ask is for them to do their best.”

There has been an outcry in Japan against the health minister though it’s unclear if he’ll resign.

Japan refuses to apologize for crimes against women

Japan admits its army forced women to be sex slaves during World War II but has rejected compensation claims.

Historians believe at least 200,000 young women captured during World War II were forced to serve in Japanese army brothels.

A large number of the victims – who were known as comfort women – were Korean, but they also included Chinese, Philippine and Indonesian women.

The media’s portrayal of young women as sex objects harms girls’ mental and physical health, US experts warn.

Magazines, television, video games and music videos all have a detrimental effect, a task force from the American Psychological Association reported.

Sexualisation can lead to a lack of confidence with their bodies as well as depression and eating disorders.

For more information on kids and sexualization, see Dr. Stryer’s recent blog post.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

So you want to be a sperm donor?

In a recent article in the New York Times the process of sperm banking was described in a fairly whimsical way, but the real bizarreness of the business could be found between the lines. Apparently sperm banks compete with one another as they go to all kinds of lengths to tout the quality of their donors:

“It’s kind of an arms race,” explains William Jaeger, director of Fairfax Cryobank, in Fairfax, Va., which, along with California Cryobank, based in Los Angeles, is among the largest sperm banks in the country.

“One year someone adds a personality profile, the next year someone adds something else,” Mr. Jaeger says. “If one of your competitors adds a service, you add a service.”

Certain donor profiles are particularly popular, making it difficult for the supplier to keep up with the demand.

The most-requested donor is of Colombian-Italian and Spanish ancestry, is “very attractive, with hazel eyes and dark hair,” and, Ms. Bader adds, is “pursuing a Ph.D.”

The bank’s files have one man, Donor 1913, who fits that description.

Donor 1913, the staff notes in his file, is “extremely attractive,” adding in a kind of clinical swoon, “He has a strong modelesque jaw line and sparkling hazel eyes. When he smiles, it makes you want to smile as well.”

Donor 1913 is an all-around nice guy, they say. “He has a shy, boyish charm,” the staff reports, “genuine, outgoing and adventurous.”

He also answers questions, including, “What is the funniest thing that ever happened to you?”

Donor 1913 relates an incident that occurred when he asked his girlfriend’s mother to step on his stomach to demonstrate his strong abdominal muscles.

“As she stepped on top of my stomach, I passed gas,” he writes.

Is Don Juan the gas-passer also the most popular donor at Fairfax Cryobank?

The sperm banks say that they only accept 1-3% of donors, but the criteria that I could glean from the article seemed to be:

  1. You’re not overweight
  2. You’re tall (unless you’re a doctor or a lawyer, then you can be as short as 5’7” to 5’8”)
  3. You’ve got a college degree
  4. You have high SAT scores
  5. You are good looking
  6. You have healthy sperm

Apparently, the most requested sperm donor in one of the California banks is a tall man who was in college at the time of his donations, but who later dropped out and took up residence in a mobile home park and made a living walking other people’s dogs.

So, who were the other 97% who didn’t make the cut?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

Electronic medical records: are we there yet?

In a happy coincidence, my favorite blog fodder feeder sent me a link to an article about Kaiser Permanente’s electronic medical record woes a day prior to Dr. Feld’s latest post on the subject of EMRs. Dr. Feld’s thoughts on the matter will certainly help to round out this discussion.

I’ve always been fascinated by technologies that are ahead of the curve. I blame this on my parents (take note – parents can be blamed for good things). Growing up in rural Canada our family was ahead of the tech curve – we had a satellite dish before there was scrambling, we had the very first Apple computers at home, and we built our own yogurt factory complete with an advanced digitally automated temperature gauge system, before the rest of the industry had moved beyond millimeters of mercury.

In college I was the first kid with a laptop in class, and in med school I was one of the first with a PDA. I took a portable printer with me to Europe in the late 80’s to go along with my Wordstar word processing program. I thought I was pretty cool, I guess! Stirrup pants, granny boots, permed hair and pink lip gloss.  Those were the days.

Cliff Bassett recently asked me why I was working at a new company (Revolution Health) that was so cutting edge rather than remaining in clinical practice. I had never thought about why I did it before – but now I see that it was part of my pioneering pattern. There’s nothing more fun than being ahead of the curve… but it can be aggravating as well.

Technologies are awkward for their first adopters – they aren’t streamlined, they can actually take more time rather than saving it, and they can make communications with others (who don’t use it yet) more difficult. But a few of us do it anyway – we jump in head first, believing by faith that the enterprise itself is worthwhile and that once we get to version 3.0 we’ll be sitting pretty.

But what do we do when we’re at version 1.0? Normally, we just tear our hair out and send lots of “bug alert” messages to developers. But when the technology affects someone’s health, the bugs are a lot more sinister. The recent article about Kaiser Permanente’s digital growing pains is disturbing indeed:

Kaiser Permanente’s $4-billion effort to computerize the medical records of its 8.6 million members has encountered repeated technical problems, leading to potentially dangerous incidents such as patients listed in the wrong beds, according to Kaiser documents and current and former employees… Other problems have included malfunctioning bedside scanners meant to ensure that patients receive the correct medication, according to Kaiser staff.

Still, 90% of physicians use paper records, making it difficult to share information – and this is no doubt contributing to the IOM’s estimated 98,000 error related deaths/year. Dr. Feld explains the complexity of a fully functional electronic medical record:

However, a paperless chart is in reality worth little unless the information entered is usable in a relational data base format rather than word processing format. Only then, can patient care be enhanced…An effective Electronic Health Record must consist of five components

Electronic Medical Records
Personal health records (PHR)
Continuity of Care Record (CCR)
Electronic health record (EHR)
Financial Management Record (read more…)

So, the bottom line is that the EMR is in version 1.0 at Kaiser Permanente, and only a twinkle in our government’s eye. It is complicated to create, nearly impossible to coordinate, dangerous if implemented half-way, and yet utterly necessary for ultimate cost savings and patient safety.

What can we do between version 1.0 and 3.0? Prayer and vigilance come to mind… it will be up to the foot soldiers (the docs, nurses, and hospital staff) to keep patients safe while juggling paper and digital until digital can fly on its own.

How do you think we can minimize our digital growing pains?

This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

The strength of weakness

An excellent blog post was forwarded to me for comment – an Internal Medicine physician reflects on his patients’ common underlying condition: isolationism.

Today I saw patients with the following problems:

  • A person who had attempted suicide over the weekend
  • A person who was possibly acutely suicidal and was abusing narcotics I was prescribing
  • A person who is in an abusive relationship and has a severe eating disorder
  • A terribly depressed woman in a dysfunctional marriage
  • A pre-teen child whose father had suddenly died

My observation from today is that most of these people are isolated.  They have difficult situations to face and the people who normally surround them are somewhat uncomfortable, not knowing what to say…

Western culture is obsessed with avoiding suffering.  We entertain ourselves to avoid having to face the harsh realities of life.  People die and suffer daily, and we are obsessed with the latest TV show, the latest political soapbox, or the latest self-help tool.  We feel that the goal of society is to create happy and secure individuals.  This is not true.  The goal of society is to function as a unit in a healthy way – with the weak parts supported by the strong ones…

What I emphasized to the people I spoke with today was the need to find people who had gone through the same things.  Those in the eye of the storm need to hear from people who have gotten to the other side that it is OK to feel the way they feel.  Those who have gone through hard times have something huge to offer those who are going through them now – experience.  You lose the pat answers when you have suffered yourself.

It is my hope that those who are struggling will find others online here at Revolution Health who can support them, and that those who have made it through to the other side will reach out to help others through our online community. Suffering is not meaningless if you harness it for good – your wounds can heal others.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

More germs found on desk tops than toilet seats

Microbiologist Charles Gerba has made a career out of scaring people with news of how dirty seemingly innocent surfaces can be.  Dr. Gerba has taken media on germ tours of kitchens, bathrooms, and offices, and now in his new research study he finds that office desks have 400x more bacterial colonies than toilet seats.  Moreover, he found that women’s desks generally have 4x more bacteria than men’s.  He attributes this to women having more makeup and food products in their desks, as well as having greater contact with small children.

Well, before we all become totally grossed out and paranoid, lets think for a minute about this.  If there are so many bacteria all around us (even on our desks) and we’re generally not sick, then I guess we shouldn’t all rush out to buy bleach and sanitizers.  Other studies suggest that sanitizers disrupt the natural ecosystem around us, creating resistant organisms that are harder to kill.

Personally, I think that precautions should be taken to reduce transmission of viruses and bacterial infections (especially in the hospital environment) but that it is unreasonable, and perhaps even harmful, to wage an indescriminate war on all bacteria everywhere.

If your loved ones are sick, minimize your exposure to their droplets, wash your hands frequently, and sanitize surfaces that they are in direct contact with.  Otherwise, if you’re feeling well, I wouldn’t worry too much about bleaching your desk surface.

As one microbiology lab says,

“Support bacteria.  It’s the only culture some people have.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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