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Medicine and Society, SMS Unplugged

Why I screamed when my boyfriend hugged me

Why I screamed when my boyfriend hugged me

SMS (“Stanford Medical School”) Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the SMS Unplugged category.

black and white rocksI was checking my email when it happened. My boyfriend had texted me saying that he was late arriving to the airport. So I stood outside with my suitcase behind me and clicked to an email from my mother.

I didn’t notice until too late that someone had approached me, and I screamed when I saw a black man reach out to grab me from the corner of my eye. Before the sound reached my ears, I realized it was my boyfriend, excited to have surprised me. I unfroze my arms as quickly as possible and embraced him.

We never talked about it. In the car ride back to Stanford, where we were both seniors, we talked about our upcoming spring break. I wondered if he had noticed other people on the sidewalk turn to stare at us. I wondered if he would ever surprise me at the airport again.

Mostly though, I chewed on the newfound knowledge that I had prejudices. Would I have screamed if a white man had grabbed me? An Indian man? A Hispanic man? Probably. I knew girlfriends who had been assaulted by all of the above during our time in college.

Regardless though, the thought in my mind when I screamed was not fear of being assaulted, it was fear of a black man. And I’m so ashamed to put this to words. I am half white, half Hispanic and grew up with a family that values diversity. I have been blessed with friends of all different backgrounds. So if I, with a liberal, multicultural upbringing had a prejudiced reaction in a moment of stress, I shudder to imagine what lies dormant and unrecognized in other people’s minds.

The question is not whether we are prejudiced. We are. Every single one of us in some way or other categorizes people by how they look and assign a danger factor to them. It’s how we are biologically wired to survive in nature.

The question is what we are going to do about it. In the quiet of our own home when no one is watching, are we going to unpack our assumptions and examine how we can improve ourselves? Are we going to encourage each other to go out of our comfort zone, to open ourselves to ridicule for admitting that we are imperfect, to challenge ourselves to be better?

My boyfriend and I are no longer together. We are at separate medical schools and I know that one day, when we are doctors in our respective specialties, I may call him for advice on the health of a loved one. I know that I will trust him more than I trust many of my peers who happen to be white.

And it hurts me to know that sometimes, it won’t matter that he has a gentle soul. Sometimes, the world will see him as dangerous before even looking.

Ferguson has hit our nation, our people, hard because it lives in every home – black, white, yellow, red or brown. It’s not a controversy over hyper-reactive policemen or a history of slavery. It’s a slap in the face that every single one of us has to own up to our discriminatory thoughts and grow. Americans need to grow as people and as a people. We the people need to become a we, not an us and a them.

Natalia Birgisson is a second-year student at Stanford’s medical school. She is half Icelandic, half Venezuelan and grew up moving internationally before coming to Stanford for college. She is interested in neurosurgery, global health, and ethics. Natalia loves running and baking; when she’s lucky the two activities even out.

Photo by Chris_J

In the News, Infectious Disease, Medical Education, Medicine and Society, Patient Care

A doctor’s attire – what works best?

A doctor’s attire – what works best?

Lab CoatsDoes what your doctor wear matter to you? You may simply want your doctor to be competent and compassionate, but a recent article in The Atlantic points out some subtle issues in the effects a doctor’s dress may have. Most people seem to prefer “formal” to “casual,” but the author recalls being put off by a well-coiffed female doctor dressed in a smart business suit. But if there’s such a thing as too formal, a doctor in cut-off shorts and a tee isn’t likely to get too many repeat patients either.

I’m pregnant and I have a toddler, so I’ve had more than the average number of visits to the doctor in the past couple of years. I also like clothes and notice what people are wearing, but even I had to stop and think about what, if anything, I remembered about what my OB/GYN or my daughter’s pediatrician (both women) wore during recent visits. Mostly I remember slacks and simple blouses, or in the unforgiving summer heat typical in this area, something a little lighter. My daughter’s pediatrician also has a couple of small Disney character toys attached to her name tag to entertain the youngest patients.

There’s a middle ground that doctors have to strike that may be tricky depending on their specialty, their hospital or clinic’s dress codes (Mayo Clinic requires all docs to dress in a business suit) among other things. And that’s not even considering the issue of how a doctor’s clothes can spread infectious disease. From the article:

The definition of what counts as professional clothing is also in flux, thanks to increasing knowledge of infectious risks. Earlier this year, the Society for Healthcare Epidemiology Association (SHEA) published new guidelines for healthcare-personnel attire in hospital settings. Their goal was to balance the need for professional appearance with the obligation to minimize potential germ transmission via clothing and other doodads like ID badges and jewelry and neckties that might touch body parts or bodily fluids. The SHEA investigators’ take-home points regarding infection: White coats should be washed weekly, at the minimum; neckties should be clipped in place (70 percent of doctors in two studies admitted to having never had a tie cleaned); and institutions should strongly consider a “bare below the elbow” (BBE) policy, meaning short sleeves and no wristwatches or jewelry. Although the impact on reducing the risk of infections remains to be determined, it’s considered potentially significant enough that a number of countries have adopted BBE requirements for all clinicians. (And it leaves me wondering: When will the Mayo clinic update its dress code to short-sleeved business suits?)

The other factor doctors have to consider is that the “business casual” that I’ve seen on most doctors may need to be upgraded for more formal meetings – something I’d never considered as a patient. Again from the article:

Last week, two days in a row, I ran into a colleague who’s a pediatrician. The first day, she wore a beige pantsuit (I’d label it formal, or business) and looked fairly corporate. I wondered to myself if she realized that her clothes were sending a message to her patients, a message that indicated that her medical practice was a business and that she wielded the power. The next day, she wore a loose-fitting knee-length navy dress (professional informal, perhaps, or smart casual). I asked her if she had seen patients the first day. She had not; it was a day of meetings, and when I told her I was writing about doctors’ clothing, she laughed. “When you’re seeing patients,” she said, “you have to look like you’re not afraid to get dirty.”

I’m not sure how I would have reacted if at our first appointment our pediatrician had worn a formal business suit. At the very least, I would have felt under-dressed (jeans and tees are my de facto uniform these days), but I would have likely judged her as cool or somehow distant, not suited to working with kids. Which may prove nothing, but only hint that that the best attire is the kind that your patients don’t notice.

Previously: NY bill proposes banning white coats, ties for doctors
Photo by Pi

Medicine and Society, Neuroscience, Public Safety, Research, Stanford News

Smooth, safe landings stem from senior pilots, study shows

Smooth, safe landings stem from senior pilots, study shows

passenger-plane-19469_640Sometimes planes thump onto the runway. The wheels smack into the ground — bam! Other times planes bounce down — ka-thump, ka-thump, ka-thump. And once in awhile, in those most beautiful of landings, planes simply float down, the wheels gently stroke the runway, the transition from air to ground seamless and smooth.

Those landings are more likely to occur when an experienced pilot is at the helm. The experience allows top pilots to accurately assess their surroundings, while displaying less brain activity than less experienced pilots, according to a study published recently in PLOS One.

A team led by Stanford and VA Palo Alto Health Care System researchers used an fMRI machine to examine the mental activity of 20 pilots as they landed planes using a flight simulator. A Stanford release explains the study:

The trial started the pilots at 350 feet of altitude. They were instructed to begin their descent based only on their instrument readings, as would be typical in most real-life flights. Once they reached 200 feet — the altitude at which the Federal Aviation Administration mandates you must be able to clearly see the runway in order to land — the program would display the runway, either clearly or obscured by varying degrees of fog.

The pilots would then need to flash their gaze from the instruments to the runway and back to make a snap decision about whether or not it would be safe to continue the approach.

Landings are the most dangerous part of a flight.  The study showed that the more experienced pilots made correct landing decisions 80 percent of the time, while displaying only half as much brain activity. The newer pilots made correct landing decisions 64 percent of the time:

“The data show that the expert pilot seems to just know what to look for, where to look and when to look,” said Stanford psychiatrist Maheen Adamson, PhD… “And we’ve been able to trace that skill back to the caudate nucleus.”

This is an area of the brain involved in regulating gaze as the eyes quickly shift their focus to different fixed objects. The work needs to be replicated to confirm the caudate nucleus’s role in instrument scanning, Adamson added.

Adamson noted that pilot training programs may be able to improve performance using brain imaging techniques in the future.

Previously: Medical mystery solved: Stanford clinicians identify source of Navy pilot’s puzzling symptoms, Being bilingual “provides the brain built-in exercise” and Image of the Week: Uncovering brain-imaging inaccuracies
Photo by PublicDomainPictures

Genetics, In the News, Medicine and Society, Research

James Watson to put Nobel medal on the auction block

James Watson to put Nobel medal on the auction block

DNA Template molecular modelLooking for the perfect holiday gift for the science geek in your life? Have an extra $3 million sitting around? If so, you can bid on James Watson’s Nobel Medal, which will be auctioned off by Christie’s on December 4 and is expected to fetch between $2.5 and $3.5 million. Watson, now 86, won the Nobel Prize in Physiology or Medicine in 1962 for deciphering the structure of DNA, along with Francis Crick and Maurice Wilkins. An article in Reuters noted the significance of the medal’s auction and the 1953 finding for which it was awarded:

“It is recognition of probably the most significant scientific breakthrough of the 20th century and the impact of it is only being played out now in the 21st century,” said Francis Wahlgren, international head of books and manuscripts at Christie’s. “Whole industries have developed around it.”

Countless subsequent scientific discoveries in the last half century have their foundation in Watson and Crick’s work. Last year, Francis Crick’s Nobel medal garnered $2.27 million. Watson’s handwritten notes for his acceptance speech will also be auctioned the same day. He plans to donate part of the proceeds from the sales to charities and to scientific research.

Previously: Coming soon: A genome test that costs less than a new pair of shoes, NPR explores the pros and cons of scientists sequencing their own genes, and Image of the Week: Watson and Crick
Photo of thymine template from Watson and Crick’s 1953 molecular model by Science Museum London

Medicine and Society, Patient Care, Technology

Advice for young doctors: Embrace Twitter

Advice for young doctors: Embrace Twitter

9093733888_79ccacf171_zYoung doctors have to juggle a huge workload, so it’s not surprising that many don’t use Twitter or other social media. But Brian Secemsky, MD, an internal medicine resident at the University of California, San Francisco recently wrote a story on Huffington Post outlining the benefits of the twitter-verse for young physicians. He notes that Twitter can serve as a good source of medical knowledge and writes:

By choosing a good mix of these medical profiles, especially those that tweet links to high-yield content, you are able to create an individually tailored and constantly updated curated source of medical information, freely available at any time.

(@StanfordMed is one of those profiles, in our humble opinion)

He also points out that Twitter is a good way for up-and-coming physicians to interact with others in their specialty and a place to for them to voice opinions about topics important to them. Also, these days, doctors have a presence online whether they plan to or not, so it’s best to take control of that image. Secemsky writes:

Whether you like it or not, your professional image will likely end up on the Internet. It may be through the increasing patient use of physician rating websites or your own institution displaying your professional profile and accomplishments. It will be difficult to avoid the impact of the online community in your medical career.

Previously: How can health-care providers better leverage social media to improve patient care?More reasons for doctors and researchers to take the social-media plungeSubjects for doctors to avoid when using social media, How, exactly, can Twitter benefit physicians? and How can physicians manage their online persona? KevinMD offers guidance
Photo by Kooroshication

Aging, History, Medicine and Literature, Medicine and Society, Stanford News

Stanford humanities scholar examines "the youngest society on Earth"

Stanford humanities scholar examines "the youngest society on Earth"

Young and old faces Over the past decades, our society has undergone a process of “juvenescence” that, according to Stanford professor Robert Harrison, PhD, makes it the “youngest on Earth.” For the first time in human history, he says, “the young have become a model of emulation for the older population, rather than the other way around” (as quoted in Stanford Report). The post-war period “has unleashed extraordinary youthful energies in our species and represents one of the momentous revolutions in human cultural history.”

Harrison is a professor of Italian literature whose new book Juvenescence: A Cultural History of Our Age examines the cultural forces that have brought about this development. The term “juvenescence” draws on the biological concept of neoteny, or the retention of juvenile characteristics through adulthood. Harrison’s research spans literature, philosophy, and evolutionary science.

His basic argument is that “juvenescence” can refer to either a positive or a negative change, and it isn’t clear which more accurately describes our current situation. The positive sense is one of cultural rejuvenation, while the negative one denotes juvenilization. Harrison explains, citing examples from his book:

Rejuvenation is about recognizing heritage and legacy, and incorporating and re-appropriating historical perspective in the present – like the Founding Fathers did when they created a new nation by drawing on ancient models of republicanism and creatively retrieving many legacies of the past… Unlike rejuvenation, juvenilization is characterized by the loss of cultural memory and a shallowing of our historical age.

…I feel ambivalent about where we are culturally in this age of ours.  It is hard to say whether we are on the cusp of a wholesale rejuvenation of human culture or whether we are tumbling into a dangerous and irresponsible juvenility.

Several aspects of our society suggest juvenilization. Most citizens of the developed world today enjoy the luxury of remaining childishly innocent about what they operate, consume, and depend on in daily life, while “in terms of dress codes, mentality, lifestyles and marketing, the world that we live in is astonishingly youthful and in many respects infantile.” Our culture’s emphasis on innovation and change honors the youthful drive that brings renewal and progress, but, without firm roots in the stability and wisdom of older generations and longstanding institutions, this risks being a meaningless chase after novelty. Youth’s genius is a luxury that requires solid foundations.

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History, Medicine and Society, Research, Stanford News

Stanford Egyptologist discovers that public health care has ancient roots

Stanford Egyptologist discovers that public health care has ancient roots

Anne Austin

Anne Austen, PhD, a post-doctoral researcher in Stanford’s history department, recently conducted the first detailed study of human remains at what is now called Deir el-Medina, an ancient town outside of the Valley of the Kings in Egypt. She found that these Egyptians likely had state-sponsored health care with “modern” benefits like paid sick days and clinics. They also felt a strong pressure to do grueling work, yet took care of their disabled and infirm.

Austen works in the relatively new field of osteo-archaeology, which enables researchers to deduce details about people’s daily lives from their skeletal remains. Archaeologists have always been interested in how remains are positioned relative to the rest of the site, but Austen tested the bones themselves to determine what diseases the people were experiencing, and then contextualized that information within the copious written records from Deir el-Medina in its heyday, when it was a bustling village of workers building the pyramids. She has added a new dimension to the picture of ancient medicine and care already gleaned from this uncommonly literate group’s receipts, personal letters, bills, prayers, and lawsuits, found on shards of clay or scraps of papyrus.

During her current tenure in the Andrew W. Mellon Fellowship of Scholars in the Humanities, she is continuing the PhD research she conducted in 2012 while at UCLA. In a Stanford News piece, she commented, “The more I learn about Egypt, the more similar I think ancient Egyptian society is to modern American society. Things we consider creations of the modern condition, such as health care and labor strikes, are also visible so far in the past.”

Austin thinks that research about Egyptians is particularly compelling for thinking about today’s questions of wellness and social responsibility because they thought of health and disease in ways surprisingly similar to our own. In contrast to the Greeks, who, as Austin points out in the article, thought of disease as an imbalance of the body’s four fluid humors, Egyptians thought of disease as a contamination, a foreign substance that must be purged. This is essentially analogous to modern germ theory. Furthermore, they negotiated the question that underlies much current American discussion about healthcare: Who is responsible for whose health, and why? Austen explains:

At Deir el-Medina, we see two health care networks happening. There’s a professional, state-subsidized network so the state can get what it wants – a nice tomb for the king. Parallel to this, there’s a private network of families and friends. And this network has pressure to take care of its members, for fear of public shaming, such as being divorced for neglect or even disinherited.

Photo courtesy of Anne Austin

In the News, Medicine and Society, Mental Health, Pediatrics

Advice and guidance on teen suicide

Advice and guidance on teen suicide

12389778613_ed6496a72f_zNot again, I thought as I read the opening line of a recent Palo Alto Weekly op-ed: “As a community we are grieving.” Reading further, my fears were confirmed: Now, additional teens have died by suicide in this California city.

A handful of years ago, I was a reporter for the Weekly. I was so grateful to cover city government, rather than schools — what a pressure cauldron, I thought at the time. As a teen, I too struggled with perfectionism, the drive to earn straight As and attend a top college, while excelling at extracurriculars. How awful to be surrounded by others like me, I thought.

Of course this is a one-dimensional glimpse at the problem. Suicides aren’t explained by perfectionism or academic stress and they certainly aren’t a Palo Alto-only problem. Shashank Joshi, MD, a child psychiatrist with Lucile Packard Children’s Hospital; Palo Alto Medical Foundation physician Meg Durbin, MD; and Sami Harley, a mental-health specialist, discuss this and other issues in a piece written to offer guidance to the saddened community. “Suicide does not have a single ’cause.’ Many factors and life circumstances must be taken into account,” they write.

They go on to clarify misperceptions about depression, an underlying condition that can make suicide or suicidal thoughts more likely:

Depression isn’t something you can or must just ‘deal’ with on your own… Though positive thinking can be an important part of having a healthy and resilient life, positive thinking by itself does not treat clinical depression. Talk therapy with antidepressant medications, if needed, are the only proven treatments for teen depression.

These local experts have held depression education and suicide-prevention training sessions with several thousand students at the two Palo Alto public high-schools since 2010. “Solutions must come from all those who interact with youth, including schools, parents and family, friends, medical and mental health providers, community and faith leaders and mentors,” they conclude.

Previously: “Every life is touched by suicide:” Stanford psychiatrist on the importance of prevention, Lucile Packard Children’s Hospital partners with high schools on student mental health programs  and Volunteers watch train crossings to prevent suicides
Photo by jimmy brown

Events, Global Health, HIV/AIDS, LGBT, Medicine and Society

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

Changing the prevailing attitude about AIDS, gender and reproductive health in southern Africa

5015384107_517a74d0b5_zDuring the 1990s and early 2000s, HIV/AIDS pummeled through southern Africa killing thousands. Although the epidemic has abated somewhat, the disease is still spreading through certain communities, including the lesbian, gay, bisexual, transgender and intersex (LGBTI) population.

In Zimbabwe, where homosexuality is illegal and President Robert Mugabe has actively spoken out against the LGBTI community, health-care provider Caroline Maposphere works behind the scenes, trying to change the prevailing attitudes and laws without sparking a homophobic backlash like that in Uganda. Maposphere, who serves as a nurse, midwife, chaplain and gender advocate, will visit the Stanford campus this evening to discuss her efforts.

“She tells great stories about how you deal with the kind of social and community issues that lie around HIV prevention and gay and lesbian health issues in a very homophobic and resource-poor environment,” said David Katzenstein, MD, a Stanford infectious disease specialist who met Maposphere in 1992 while working on the Zimbabwe AIDS Prevention Project.

Preventing the spread of HIV in Zimbabwe isn’t as simple as handing out condoms or launching an education campaign, although those are key strategies, said Maposphere. The nation is poor, has few health-care facilities of any kind and LGBTI rights are non-existent. The traditional southern Africa culture view of homosexually, which was sometimes attributed to witchcraft, further complicates the issue.

“It’s very difficult to reach out with services to groups that are not coming out in the open,” Maposphere said. “We try to reach out and remove some of the barriers through discussion rather than being outright confrontational.”

Maposphere often encounters LGBTI individuals who feel they have been shunned by God and have been excluded from their churches in the predominantly Christian nation. In an effort to offer spiritual guidance as well as health care, she earned a college degree in theology and hopes to explore the religious aspects of her work while at Stanford.

In addition, Maposphere is planning to connect with gay-rights activists here and learn effective methods for countering homophobia in her native country. “I’m very hopeful that things will change,” she said.

The free discussion begins at 7:30 PM in the Vaden Education Center on the second floor of the health center on campus.

Previously: Remembering Kenyan statesman and Stanford medical school alumnus Njoroge Mungai, In poorest countries, increase in midwives could save lives of mothers and their babiesSex work in Uganda: Risky business and In Uganda, offering support for those born with indeterminate sex
Photo by Remi Kaupp

Ethics, Health Policy, In the News, Medicine and Society, Transplants

Moving the needle on organ donation

Moving the needle on organ donation

For the thousands of people on organ donation lists, news of an available heart, or lungs, or liver can’t come soon enough. But many don’t get that call in time. According to a new feature on The Atlantic’s website, 21 people die waiting for a transplant every day. That works out to more than 7,600 patients every year.

Unfortunately unless you’re personally touched by the issue… you don’t really think about it

Although many people say they support organ donation, in many countries, only a minority actually register as organ donors. (“Unfortunately unless you’re personally touched by the issue, unless you have a child that gets a virus and suddenly needs a new heart, you don’t really think about it,” one expert says in the piece.) It’s a paradox many people in the field are trying to unravel. The reasons they’ve uncovered so far include mistrust of medical professionals: Some people believe that if a medical team finds out that you’re an organ donor, they won’t work as hard to save your life, in order to harvest your organs. And how much TV a person watches can influence how much he or she trusts doctors. One study found that people who watched more of the TV series Grey’s Anatomy were more likely to mistrust doctors and nurses.

Religion also influences the picture, probably because of concepts of bodily integrity in the afterlife. Catholics are less likely to donate their organs, even though the Vatican officially supports organ donation.

So what can be done about the organ shortage? Some groups are working on solutions, as highlighted in the piece:

“What we’re trying to do in New York is move the cultural needle on the issue,” says Aisha Tator, executive director of the New York Alliance for Donation. “Organized tissue donation should be a cultural norm like we did with bike helmet and seatbelt interventions.” Her organization isn’t the only one. Throughout the United States there have been a smattering of recent educational campaigns and studies on their efficacy. Campaigns have targeted the young, the oldnursesDMV employees, and ethnic minorities who tend to donate less than white Americans or white Brits.

Another, more drastic change is to shift the U.S.’s current opt-in system to one that requires people to opt-out. Many experts point to Spain, which has an opt-out system – and one of the highest rates of organ donation. But the logistics of such a system would probably be difficult, best, to implement.

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