April 16th, 2009 by Stacy Stryer, M.D. in Health Tips
Tags: middle school, Parenting, Stacy Beller Stryer, teens, tweens
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By Stacy Beller Stryer, M.D.
Those middle school years …
As a parent, we often think these are years to be feared. Years that we wish we could just blink away. We hear horror stories from our friends and look at book titles, such as “Parenting 911,” and “The Roller Coaster Years,” with trepidation. If only we could run away … just for awhile.
But, if we did run away we would be missing out on some of the most rewarding and exciting times we will have with our children. Sure, I am not going to deny that middle-school age children(referred to as “middlers” by authors Charlene Giannetti and Margaret Sagarese) are emotional, moody and, at times, unreliable. But, as someone once told me, almost every negative attribute can be turned into a positive one. I guess that means that maybe, instead of being emotional and unreliable, our middlers are actually passionate and spontaneous.
Developmentally, they are expanding their horizons in many ways. This is when they develop abstract reasoning, a complex sense of humor (beyond the potty jokes), and the knowledge that there is an entire world out there for them to conquer. This is when they begin to develop strong interests, likes and dislikes, and when they begin to take greater risks – in a positive way.
Personally, I love being with my middler (8th grade) and my almost middler (5th grade) girls. They are interesting, exciting, and a blast to be with. When my 8th grader becomes passionate about something, particularly some social injustice, she can talk a mile a minute. My 5th grader can be very intense when she practices viola or writes original music for her instrument. She often performs for me while I am preparing dinner. Both are becoming much more adventurous – last month we went to an Asian supermarket and bought several canned fruits we had never heard of so we could have taste tests.
I have been thinking about these middle years recently, not only because my children are this age, but also because I have been preparing for a lecture on this topic for parents at a local school. Although I have been counseling patients for years, I have recently read several additional books on the topic in preparation for the talk. They have been helpful, although my basic parenting principles remain unchanged. They seem to be important for children and teens of all ages. I think (“Parenting, according to Dr. Stacy”) that the six key elements of being a good parent of any age child include:
1. Open communication
2. Respect and consistent discipline
3. Compassion
4. Sensitivity
5. Awareness
6. Being a role model
Although the principles remain the same over time, the way we express them varies, depending on the child’s age. For middlers, there should be a strong emphasis on sensitivity and awareness. Children in this age range tend to be very emotional and sensitive, and we need to understand and respect this. For example, they may not want to be kissed or hugged in public anymore. Or, they may need some private time after school or in the evening. We should allow them to retreat to their rooms for a certain time period before bombarding them with questions or making other demands. Respecting their needs ultimately improves communication. We should also be particularly aware of sudden or extreme changes in our middlers’ behavior, as depression, eating disorders and other problems can appear during these years.
Adapting these six basic parenting skills will certainly not ensure a problem-free middle school experience for you or your child, but it will make it much more likely that he or she will come to you in times of need and will strengthen the relationship that you have with each other. Consequently, your middler will be less likely to engage in high risk behaviors or succumb to peer pressure which occurs during these years.
April 6th, 2009 by Dr. Val Jones in Health Tips, Uncategorized
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I attended a teleconference meeting* with John Halamka yesterday at the Cisco booth at HIMSS. It was an exciting experience – and quite intimate since I was there with only 1 other reporter and two Cisco staff. The room was closed off from the exhibit hall but we could be viewed through glass and John’s face was about 4 feet tall in front of us. It actually felt a bit like a TV news room – with glowing lights, cameras, and mics everywhere.
I arrived a few minutes late because I was having trouble finding the booth with the McCormick numbering system – but Frances Dare graciously welcomed me, and John immediately responded (from the screen in front of us): “Oh, hello there new person!” It was most amusing.
I’m sure that John had said some brilliant things prior to my arrival – but I had the chance to ask him my very own questions for about 30 minutes. Here are some highlights:
Dr. Val: How are we going to get doctors in solo practice to get on board with a national EMR effort?
Dr. Halamka: What we’ve found in the Boston area is that even if you give solo-practitioners an entire online EMR system for free, they still don’t want to use it because it takes effort to learn how to do so. They’re just not willing to put in the time. However, now that there are financial incentives in place (the stimulus bill includes $44,000/doctor to adopt an EMR system), suddenly their willingness to comply has increased dramatically.
Dr. Val: How do they get the right EMR?
Dr. Halamka: Hospitals pay 85% of the development costs for a good EMR, and professional organizations pick up the other 15%. Then the EMR is licensed for free to the solo practitioners – they’re incentivized to adopt it, and all they see is an online browser. They don’t have to deal with the back end at all.
Dr. Val: Have you used voice recognition systems at your hospital?
Dr. Halamka: Yes. We’ve found that voice recognition systems don’t work well in the ER because it’s too noisy in there. Also, the nurses don’t like having to tote around another piece of electronic equipment to do their jobs. However, we love our voice recognition dictation system – I can call in my note and have it return to me to insert into the electronic chart in near-real time. That’s great. Of course, voice recognition works best for the narrative portion of a note in the medical record, it’s not so good for structured data.
Dr. Val: How are we going to get doctors on the same “practice page” so that patients receive consistent care for similar problems, no matter where they are in the country?
Dr. Halamka: We need to implement more physician decision support tools and create rule sets based on best practices/evidence. Some are already doing this successfully: Health Dialog uses nurses (via phone) to walk patients through treatment decision trees. UpToDate is a good resource for doctors. At our hospital we’ve even negotiated in advance with the local insurance plans to have them automatically approve radiology tests based on pre-determined rule sets. That saves the docs a lot of time because they don’t have to call for approval for every single radiology test that they order. If the test is indicated by the rules, then it’s automatically approved.
Dr. Val: Some doctors have had bad experiences with rule-based quality measures. One ER doc I know was reprimanded for doing the right thing (clinically) because it didn’t comply with a rule set. How do you address the inflexibility of rule sets in the face of complex human lives and situations?
Dr. Halamka: Quality measures must be based upon clinical data, NOT administrative or claims data. Administrative codes are too far removed from what’s actually happening clinically – so if we are going to automate quality scores, they have to be analyzing the right data sets. However, quality scoring is not perfect. My hospital actually got “dinged” for reporting too much. We’re very transparent at BIDMC and tried to supply all our quality measures to a local oversight body. Of course, the other hospitals weren’t reporting anything like the level of detail that we were, so we looked like an outlier – and a really bad hospital. Of course it was just an artifact. But it took some time to clear up.
Dr. Val: I once heard someone say that judging a hospital’s quality based on administrative data is like judging a restaurant’s quality by its grocery list.
Dr. Halamka: That’s a good one. I’ll have to use it. Well thanks for the call – I’m speaking to you here [points to the white curtains behind him on the screen] from my basement!
Dr. Val: Thanks for your time! I look forward to your HIMSS lecture tomorrow on what the stimulus bill means for IT.
###
*TelePresence Fireside Chat – Sunday, April 5 (3-4pm CT) – Dr. John Halamka, CIO of CareGroup Health System will conduct a live interview via TelePresence, an immersive in-person meeting experience, from his home in Boston along with Frances Dare of Cisco, who will be onsite at HIMSS. The discussion will focus on a number of issues pertaining to the stimulus funding package. Additionally, Mrs. Dare and Dr. Halamka will discuss how technology such as healthcare telemedicine and remote video will play a role in not only time and cost savings but also helping serve rural populations.
Recent AP article about Cisco.
February 25th, 2009 by Stacy Stryer, M.D. in Health Tips
Tags: adolescence, puberty, Relationships, sex, Stacy Beller Stryer, teen males, virginity
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By Stacy Beller Stryer, M.D.
I read an interesting article in the New York Times last week, “Inside the Mind of the Boy Dating Your Daughter.” When I saw the title, I was instantly drawn to it because my older daughter is going to enter high school in the fall (yikes!) and has recently begun talking about boys. She currently attends a magnet school where most of her classmates are female. She just mentioned, for the first time, that there are no boys to like in her program, which makes for boring sleepover talks (but makes her mother exceedingly happy). Given that I think she’s the cat’s meow, I thought I could get a little “inside information” from reading the article before throwing her into the world of male testosterone and upperclassmen.
However, the article totally surprised me. Coming from a family of 3 girls and having 2 daughters, myself, I am much more comfortable figuring out what a girl might be thinking or feeling than a boy. I must admit that I believed the folklore that teen boys basically have sex on their brains. But, according to a study recently published in the Journal of Adolescence, this is not the case. Researchers had 105 10th grade teens complete a survey about sex, love and relationships. Reportedly, most boys said the main reason they would date someone was because they “really liked her.” The second most common reason they wanted to date someone was to get to know her better, and because they were physically attracted to her. Of note, 40% of the boys stated that they had already been sexually active and 14% wanted to have sex to lose their virginity. We must remember, however, that this was a relatively small sample size done in one school.
As a follow-up, the New York Times asked people to send in their comments about the article, and they discussed the results in the Week in Review. Many of the comments sent in were from adult men, who didn’t believe the teens answered honestly because, as these adults remembered, (?is their memory correct) they thought about sex, and only sex as teens.
An important and notable comment made by Dr. Andrew Smiler, the author of the study, is that parents are less likely to talk to their sons about relationships than their daughters. He stressed the need to talk to boys frequently about relationships, respect, trust and sex.
This gives me some hope that my daughter won’t be bombarded with a storm of testosterone the moment she enters high school. Actually, I am not too worried because I have been preparing her for the world of “boys” since she was much younger. For years we have talked about puberty, and as she has become older we have added relationships, values, possible uncomfortable situations, and waiting to have sex. I believe that this will carry her a long way. And, according to research, I am right, because telling a teenager to wait to have sex actually makes it more likely that they will.
As parents, we must remember to talk to both our daughters and our sons. Our discussions should start early. In elementary school, they should know what puberty is and how boys and girls develop. They should also learn about love and respect. As preteens, they should have talks regarding dating, relationships, and sex. If you wait too long, they will not hear you, or they will already have had to deal with a sexual situation and may not have known how to handle it. Amy Mirion and Charles Miron, authors of How to Talk With Teens About Love, Relationships, and S-E-X, also discuss how important it is to have small, ongoing dialogue rather than the one “big sex talk.” They suggest that, when parents talks with boys, they be direct and simple, and that they include topics such as love, respect, and values. They also stress the need for boys to actually be told to wait before having sex.
Just in case, maybe I’ll send some pepper spray to school with my daughter next year …
For more information on how to talk to your children about relationships, sex, and other risky behavior, check out the following websites:
4parents.gov
WebMD
Children Now
January 22nd, 2009 by Stacy Stryer, M.D. in Health Tips, Opinion
Tags: Child, Inauguration, Parenting, Pediatrics, President Obama, role model, Stacy Beller Stryer
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By Stacy Beller Stryer, M.D.
We are asking a lot of President Obama. We are asking him to end the wars around the globe, help societies in need, bring jobs and prosperity back to the United States, provide healthcare for all Americans, improve our children’s education, and so on. In his inaugural address, President Obama agreed to tackle many of these issues. We must remember, however, that he is not Superman. He has told us many times, including yesterday, that he cannot make these changes alone but needs the help of all Americans. As he said, “What is required of us now is a new era of responsibility – a recognition on the part of every American, that we have duties to ourselves, our nation and the world …”
Why am I, a pediatrician, discussing an inaugural speech on a website about healthcare? Because, as the President said, each and every one of us has the responsibility of contributing as much as possible to our society and to the world-at-large. As a pediatrician, one of my responsibilities is to guide mothers and fathers toward being the best parents possible. As a parent, each of you has the responsibility of doing the best job you can in raising your children, even before they are born. This means eating well, and refraining from smoking and drinking during pregnancy. It also means providing for them in as many was as possible. This includes, not only giving them appropriate clothing and food, but also stimulating their minds and hearts. It means treating them with respect, acting as positive role models, and teaching them right from wrong – why smoking and having sex as a teen is wrong, why doing well in school is important, and why all people should be treated equal, whether they are black or white, straight or gay, fat or thin. It means boosting your children’s self confidence and letting them know how much you love them. It means becoming involved in activities which help the environment, community, and those in need. And when children become teens, parents must also change their ways – they must learn to recognize when teens need space and when it is time for them to develop their independence.
President Obama is certainly asking a lot of us. But I know we can rise to the occasion. By being good parents and role models, we will not only have fulfilled our duties and responsibilities, but we will also have prepared the next generation to do the same. Here’s to President Obama – and to each and every parent in America.
December 31st, 2008 by Dr. Val Jones in Health Tips, Opinion, Primary Care Wednesdays
Tags: AAFP, Doctokr, Doctokr Family Medicine, Dr. Steve Simmons, Family Medicine, New Year's Resolution, Quitting Smoking, Stages of Change, Weight Loss
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By Steve Simmons, MD
What do New Year’s Resolutions tell us about ourselves? Will they cast light on our hopes for the coming years or embody regrets best left in the year past? Resolutions tell us about our hopes, about who we want to be, and if made for the right reasons can lead us to the person we wish to be tomorrow. A positive approach utilizing the support of family, friends, and caregivers will help us follow through with our resolutions and improve our chances for success.
For the last two years, resolutions to stop smoking, drinking, or overeating, have ranked only ninth on the New Year’s Resolutions list, while getting out of debt, losing weight, or developing a healthy habit are the top three. If you find this surprising, you are in the company of many physicians. Yet this demonstrates the positive approach preferred by a majority making a New Year’s resolution. For each person making a resolution to stop or decrease a bad behavior, five choose to increase or start a good behavior, instead. We can learn from this and maintain a positive focus when considering and following through on a resolution. Keep in mind that only 40% find success on the first try and 17% of us need six tries to ultimately keep a resolution.
Avoid making hasty New Year’s resolutions based on absolute statements, which all too often meet with failure at the outset. We recommend an approach based on The Stages-of-Change-Model, developed from studying successful ex-smokers. For 30 years, primary care doctors have used this model to help their patients successfully rid themselves of a variety of bad habits. The Model’s foundation is the understanding that real change comes from within an individual.
Below, I’ve outlined the five typical stages a person progresses through in changing a behavior, using the example of a smoker:
1. Stage One/Pre-contemplative: This is before a smoker has thought about stopping.
2. Stage Two/Contemplative: A smoker considers stopping smoking.
3. Stage Three/Preparation: The smoker seeks help, buys nicotine gum, etc.
4. Stage Four/Action: The smoker stops smoking.
5. Stage Five/Maintenance and Relapse Prevention: Still not smoking, but if our smoker smokes again, keeps trying to stop, learning from mistakes.
The family and friends of a resolution maker are an intrinsic part of success and should avoid a negative approach. Instead, help them move through the stages, advancing when ready at their own pace. The following exchange is typical of an office visit where a spouse’s frustration spills over, finding release:
“Dr. Simmons, Tell John to stop smoking!” John’s wife demands of me.
“Mr. Smith, you really should stop smoking,” I request of John.
“Well Doc, I don’t want to and that’s not why I’m here,” John says, pushing his Marlboros deeper into his shirt-pocket, clearly agitated with his wife and me.
“I’m sorry Mrs. Smith, John doesn’t want to stop, perhaps I could hit him over his head, knock some sense into him?”
Once negative energy has been interjected between me and my patient, I struggle to find an appropriate response. Should I use humor to redirect? I have rarely seen someone stop a bad habit after being berated. I would prefer a chance to help him think about smoking and how it’s affecting his health. Does he know that smoking is making his cough worse? Has he been thinking about stopping lately? Nagging seems to be more about our own frustration than a desire to help and should be avoided since the effect is usually the opposite intended.
A resolution can show the path to a happier and healthier life. If you or someone close to you is planning to make a New Year’s resolution, just start slow, stay positive, have a strong support network….and one more thing: Resolve to stay Resolved.
