Dear ACGME,

As a 4^th year medical student I highly value the work that you do in ensuring my training in residency will be sufficient.   However, I am horrified to learn that you are proposing the removal of family planning training guidelines for family practice residents.  Many US women go to a FP as their primary healthcare provider for comprehensive health care – from the treatment of acute sickness to the delivery of their babies and everything in between.  The vast majority of women in the United States use contraception.  Now, if a FP isn’t trained to provide their female patients with counseling on contraception, pregnancy options, and the such, where are these women expected to turn?  It is an equation that makes no sense at all and will lead to subpar care for many US women, especially poor women and those in underserved communities. 

Please do not change the requirements for family planning physicians.  Women count on their providers, and we as providers need to be trained in how to provide comprehensive reproductive health care.  If we’re not trained, then who will be?  It is your responsibility as an accrediting organization to look out for our best interests as future physicians and the best interests of our future patients. 

Thank you,

PAIT

 

I wrote my letter - now where is yours?

 

ACGME is debating cutting family planning training for family medicine residents.  They are accepting feedback through tomorrow.  Please speak up, and ask everyone you know passionate about this issue to do the same. 

Comments are being accepted at familymedicine@acgme.org.  Also, the Reproductive Health Access Project has an online campaign going here.  More information can be found here.

And tangentially related, what is going on in Kansas is disturbing.

Passing stones

I'm pretty sure I had my first kidney stone this weekend, which also means this weekend went nothing like it was planned.  The presentation was classic: sudden onset severe flank pain radiating into my pelvis, nausea without vomiting, clamminess without a fever, and urinary urgency.  Of course, the pain started on my way home from work on Friday night, right after all the doctors' offices and urgent care centers had closed, and right before the start of shabbat. 

 I went through the differential: kidney stones, pyelo, appendicitis, hemorrhagic ovarian cysts, ovarian torsion.. but was very aware that the pain was primarily flank pain.  I called my med school roommate to calm me down, talk through the differential, and come up with a plan.  800mg ibuprofen, hydrate as much as possible, use a heating pad, reevaluate in a few hours.  The pain escalated but the heating pad made it bearable.  Our shabbat dinner guests arrived.  One guest encouraged me to call my PCP to talk to the on-call doc.  It turns out my own doc was on-call, strongly felt that I was passing a stone, and advised I go to the ER for IV fluids, stronger pain meds, and a confirmatory CT scan. 

A friend drove me to the ER.  We waited an hour, in which the waiting room became increasingly filled with people who appeared to have all types of communicable germs.  I couldn't sit comfortably or stand in one place and so I paced in the corner.  I hadn't yet even been triaged.  I wished I wasn't such an honest person, knowing that had I reported my chief complaint as chest pain + SOB, I would have been seen immediately.  I freaked myself out about a CT, about exposing my ovaries to needless radiation.  And so after an hour I checked myself out of the que and we left, knowing that either it was a stone and would declare itself or something would get significantly worse and I would be back.

The next 24 hours were a slow mix of adjusting the heat pad, re-dosing on NSAIDs, drinking as much as I possibly could, peeing, sleeping, and trying to read a book.  Not how I had planned to spend shabbat.  My urine turned cloudy a few hours after the pain began- furthering my suspicious that it was a kidney stone.  And then, sometime last night, the pain stopped.  It has left my body sore and exhausted, wondering if maybe I made it all up?  That's the downside of not having a confirmatory scan or seeing a physical stone pass... now I always get to wonder if it was a stone or not.  Really, could I have imagined all of the last 36 hours?  And it is a pretty compelling story indeed...  But, the true question is, would I believe a patient that came in and told me all of this? 

30 things before 30

I turn 29 very soon, very very soon.  Here is my bucket list of things I want to accomplish before I turn the big three-zero.  I'm posting it publicly to keep me accountable.  I imagine that a lot of these things will absolutely happen and some will not.  What fun would it be to have a completely obtainable list?  Here is to a year of adventure and personal growth!

Health:
1. Challenge myself physically (current plan is a 120 mile bike ride)
2. Learn a new sport or exercise
3. Have an a1c < 7.5
4. Learn to consistently use, and fully utilize, a CGM / my dexcom sensor
5. Loose the last 20 pounds to fully get to my goal weight

Career:
6. Have a manuscript published
7. Finish my MPH requirements
8. Get a job (match into residency)
9. Graduate medical school (should happen within a month of turning 30)

Community & family:
10. Send at least one real (snail mail) letter to a friend each month
11. Call my grandmother more
12. Reach out to my borther
13. Reach out to my cousins
14. Be more patient with my mom
15. Talk to my dad

Religion: 
16. Create a ritual for clinical practice around performing births & abortions
17. Say yes when asked to lead kiddish
18. Read from the Torah again
19. Davin in shul at least once a month
20. Wrap tfillin at least once a month
21. Join a chevra kadisha

Misc:
22. Address my fear of heights
23. Travel to a new place, besides residency interviews
24. Renew my scuba certifcation
25. Go on at least 1 date every two months
26. Do at least 5 touristy things in the city I go to medical school in
27. Spend a night out dancing without caring that I can't dance
28. Learn embroidery 
29. Stop wearing clothes that I've had since high school
30. Relearn Spanish

And one for good luck:
31. Save the world