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The Real Fantasy Of Star Trek Medicine: Doctors Without An Administrative Burden

One of my favorite summer activities is watching reruns of Star Trek Next Generation. It’s become somewhat of a summer tradition in my family the last few summers. Having become trekkies themselves, my kids were able to very much enjoy the recent movie, and get the history and lore behind it.

The longevity of the Star Trek enterprise is fascinating. Decades after it’s first launch, it still captures the imagination of inquiring minds and still provides endless hours of entertainment to viewers of all ages.

Even more amazing than the longevity of it’s run is the technology it represents. When the show first debuted, the sci fi components seemed truly out of reach. Today, much of the technology in the new movie and even some of the older shows doesn’t seem that implausible, especially when it comes to health.

Early Trek was a preview of our current Health 2.0 world. When first portrayed, that was not a concept any of us could grasp.  Think about it. In the original series, and continuing through to the latest movie, they used communicators in high tech ways with online computers to search data bases and emails and video calls to talk between doctors at different inter-stellar locations. The doctors even had high tech gizmos to look inside and offer a 3-d look within. All medical records were online and available anywhere. New advances in medicine came from experience, science as well as other cultures and the experience of the treating physician. Patients and doctors could review information online and use that to improve their own care.

What wasn’t so out of reach was the portrayal of the practice of medicine and the limitations of what the human physician could achieve. The bedside manner was always first and foremost the key element to a patient’s survival. The physician treated all patients, regardless of species, and had tolerance for different cultural beliefs in treatment. And, not all patients made it through their ordeal. After all, the doctor was “just a man, not a miracle worker”.

So, Trek’s docs were all health 2.0 with a healthy dose of health 1.0 in that they had these important features:

1. high tech gizmos and computers to diagnose and treat
2. traditional docs to take a history and offer counsel but computerized medical records
3. limits on what could be done
4. online communication with “Googling” ability
5. New advances and lessons from other species to tackle new issues and problems

Sounds a great deal like our health system, minus the insurance headaches, huh?

The practice of medicine is begging to be more health 2.0 but with doctors who very much want and need to be involved and keep their health 1.0 skills. Today we have gizmos that keep becoming more high tech…think robotic surgeons. Today we have doctors still driving clinical care with bedside manner still crucial to the success of an outcome. Today we still have limits of what can and can not be done, with a limit of human life, regardless of our efforts to prolong it. Today we have very robust online communication between doctors, between patients, between doctors and patients, and between everyone and the computer, but with an importance still placed on the face-to-face visit.

There’s one big difference between the docs on Trek and us…insurance. Because of that, what we see on Trek is still just a dream. Those docs can do their jobs so admirably and with great patient satisfaction because they are not burdened with an insurance system gone awry and not forced into cycles of defensive medical practices.

Until health reform sorts out how to allow us to have a patient-focused, physician driven system again, what we see on Trek will remain a dream. What’s sad and discouraging is that is this is one sci fi dream that is actually within reach. Don’t you think it’s time we stopped the insurance companies from preventing us from grabbing on?

*This blog post was originally published at Dr. Gwenn Is In*

Kids Pressured To Be On Academic Treadmill Year-Round

I used to feel guilty when I would say “no thanks” but not any more. I no longer by the line:  “Ok…but you do know she might get behind…many of the other kids do continue for the summer.”

I’m ok with it…and so are my kids. And, you know what, not once have they “fallen behind” in any of their activities, even the ones they are at the top of their game on, in sports or in the arts.

It’s a myth that the sports world is the only world with year ‘round pressure. The music and arts worlds have it, too. Those worlds, in fact, can be more insidious about it because it’s done under the guise of “enrichment” and “culture”. The 24/7 wear and tear on our kids bodies, minds, and souls is, nonetheless, the same as with a ‘year round sport and it’s time music, dance and other fine arts parents recognize that their kids, too, need an off season.

The way to look at it is that any school year after school activity that occupies a great deal of time and focus and goes on for most of the school year, or more than 1 celestial season, requires an off season. The model is in the pro worlds. Pro athletes get off seasons and professional dancers and musicians do take breaks from the intense rigor of their professional season.

Our children have 1 childhood and only so much time in it to explore themselves and pursue activities that interest them. Given how much of the school year’s schedule is dictated by adults, the summer is the best time to hand over the reins to our kids and find out what they want to do and make it happen. The summer is the most perfect time to spread wings and try on something new, something that they may have had to shelve by necessity during the school year.

So, don’t buy into the “she’ll get behind” line – in sports or in the arts. Give your kids the off season this summer they deserve. Just like the off season in the pro worlds, kids use the time so productively that by the time they return to their beloved passions, they have a new found energy, zeal and focus. The rust will come off amazingly quickly and they’ll surge ahead again as if the summer never occurred.

Why not just keep on going, you ask? You could…but you may end up turning an activity your kids love into a complete grind and burn them out entirely. Plus, injury rates increase dramatically in sports and the arts when kids don’t have a break. Musicians and dancers put wear and tear on their bodies just like athletes, but with different muscle groups. Those areas of their bodies need to rest and rehab, in addition to their minds and souls having a chance to not focus so intensely for a while.

Childhood isn’t about specialization, it’s about variety. We’ve forgotten that along the way, and our kids’ bodies and spirits are paying a steep price.

*This blog post was originally published at Dr. Gwenn Is In*

Talking To Teens About Social Media And Sexting

Being the first group of parents to have to have to parent an all digital generation of kids, it’s no wonder our brains go on overload trying to sort out not only how to use all things digital but keep our developing kids safe and thriving in their ever digital lives.

I talked about these issues today on Fox25 Boston and highlighted the new social media and sexting tips out from the American Academy of Pediatrics in honor of Internet safety month. Here’s the clip of the segment with all the details:

To remember the key points of the new AAP tips, I came up with the mnemonic “TECH”:

T: talk to your kids about their technology use and what they think of technology and the issues they hear about online.

E: educate yourself about the technology your kids are using, your kids about the issues, and your community about the need for youth education programs in schools as support for the issues

C: check your kids online profiles and logs often, and sometimes without warning

H: have a family tech use plan and follow-through when violations occur.

We know how to parent off line. We know how to create consequences when curfews are broken and expectations for social rules and proper behavior are not met. What we have to do now is modify our already great parenting skills to the online world. These tips are the first step!

Plus, keep in mind, you are not alone. Not only are all the parents around you in the same boat but you have experts like me here to help answer your questions about the high tech lives of kids.

I had a great chat after the segment with many FoxNews25 viewers and will post what we talked about soon so everyone can benefit. In the meantime, if you have questions about your own “Networked Family” or a story to share from your own “Networked Family” archives, email me at ideas@pediatricsnow.com.

*This blog post was originally published at Dr. Gwenn Is In*

Will Healthcare Reform Discussions Include Medical Education And Lifestyle Concerns? It should!

With health care reform being the talk of the week – a top priority for President Obama and for the AMA, who wants to be sure that America’s physicians are not just talked about in the reform process but included – I can’t help but wonder if the entire system will be reevaluated or if we will end up with just another band aid.

What worries me is that it’s not just the practical end of medicine that is broken. It is not just the billing end that is unhealthy. It’s not just the reimbursement and billing end that is broken. The overall culture of how we practice medicine is broken as well as the educational system in which and through which our next generation of physicians are being trained.

In this Spring’s issue of the Tufts University Medical School Alumni Magazine, my medical school Alma Mater, resident life style issues were at the core of their headline article. Reading the article, Pressure Drop, by Susan Clinton Martin, M.D., M.P.H, ’04, a pediatrics resident, I was at times propelled back in time to my pediatrics residency at the same institution in the early 1990’s have discussions with my adviser and residency director about whether I wanted to go part time. As I was in my junior year of my pediatrics’ residency and expecting my first child, this was not an easy decision to make and I had seen mixed results with other residents who had attempted this path before me.

In the end, I opted to not go part-time and for the reasons stated in the article for most residents not opting for this path:

1. longer length of overall residency
2. decreased pay and benefits (not ideal with a baby at home!)
3. resentment of colleagues for fear of extra work on their plates
4. lack of support of the program

The honest truth is all of these issues were at play back in the 90’s with me and my colleagues and still exist today. I opted to just forge ahead and deal with having a baby and being a full time resident. I don’t regret that decision. I had the support of some attending physicians and colleagues, friends, my husband and a wonderful nanny who a PICU (Pediatric Intensive Care Unit) Attending introduced me to. It wasn’t easy but is there ever a great time to have a baby in the medical profession? Let’s be honest – residency is one of the most challenging times for a physician and adding any stress to the plate makes it worse.

Balancing work and family is never easy for any career but particularly challenging as a doctor and incredibly challenging as a resident physician where you don’t control your time. Residency programs have rather rigid schedules and even the most thought through back up systems don’t accommodate the last minute life issues that can occur unexpectedly when you are a new parent and have a new baby at home. Residencies try to be reasonable when life issues emerge but it isn’t always easy and there is always some sort of “pay back”. Even when unexpected life issues emerge – daycare crises, infant illness, or a family crisis, it’s almost easier to find a way to get to your shift. That’s how intense the pressure is on you at the time. I recall seeing an Attending pregnant with her 3rd child in tears one day because some small issue had unraveled at home. I asked a mentor about it and she told me “You’ll see when your baby comes. Some days the pressure just gets to you. Just come talk to one of us. There are a few who understand and can help.”

Reading that Dr. Martin was brave enough to go part time was like seeing a rose among weeds. The benefit to her and her family was enormous. When working her “on” months, she can focus and feel less guilty, knowing her time with her family is coming. When she has her “off” months, she’s refreshed “emotionally accessible” to her family.

A recent study by Martin’s program director Dr. Robert Vinci showed that today’s medical students value part time options in residency programs, yet few residents are utilizing those options when they do exist and the majority of programs are still very traditional. According to the article, only 25% of US residencies have part time options with only 10% of residents in those programs utilizing the part time paths.

So, there’s a big disconnect in medical education between desire for better lifestyle and what is available, no different than what those of us who have completed our education and training have experienced within the health care system for years. While it’s discouraging that our caring profession doesn’t have a system that allows us to care for ourselves and our families, it’s encouraging that we are all finally speaking up that balance between work and home isn’t a frill but a necessity – even for physicians.

This is why it is so crucial that doctors at every level of today’s health care system not only have a voice in the health care system discussions under way but be the key players in crafting the new system. This is our career, our life’s work. We would never tell the Government how to do their jobs…what makes them think they call tell us how to do ours?

*This blog post was originally published at Dr. Gwenn Is In*

What Features Do Teens Need On Cell Phones?

Cell phones are their feature are an ever growing topic in today’s families. It used to be that the hot button issue was whether to get the phone. Now, we have to deal with all the features: texting, Internet, camera…to name the tip of the iceberg!

Clearly we’re becoming a more mobile society with our cell phones taking over features previously reserved for our computers. A recent Nielsen Wire report confirms this observation showing that in Q1 of 2009 21% of cell phone owners used their phones to search the Internet, up from 16% in Q4 of 2008.

At the moment, digital plans are pricey so it’s easy to lock our kids out of their cell phone Internet access. However, not too long ago we said the same exact thing about texting and now we have affordable unlimited texting plans.

Given the impulsivity of tweens and teens and how difficult it is for us to help kids with appropriate Internet use on computers, do we want to open the door to having them have access to the Internet on cell phones? Once data plans become more affordable, should we let them have cell phone internet access?

Perhaps it would be easier to answer if asked slightly differently. How are our teens and tweens doing with the digital cell phone freedom they have right now? Given the rise of extreme texting and sexting, I’d say not so great. Before we open the door to new issues and digital freedoms they are not ready for, we have to help them more with the freedoms they already have – and are clearly struggling with. Plus, as parents, we are still sorting out the issues with the digital uses of technology our kids are currently using. Let’s sort those out first before we give the green light to other mobile freedoms that will certainly be more complex and harder to control.

If all goes well, data plans will remain unaffordable for a while longer so we won’t have to cross another digital bridge none of us are ready for.

*This blog post was originally published at Dr. Gwenn Is In*

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