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.

Forty years later, the same damn fight

Next Tuesday will mark 40 years since Roe v. Wade, and yet, access to safe abortions is majorly limited.  Women's rights in the US are being chipped away at daily, little by little, state by state, with no safety net in sight.  I'm honestly scared to see what happens with the abortion debate over the next 40 years.  If we continue on the current trajectory... I don't even want to imagine.  I'm going to keep fighting for my rights.  Are you?

Here are what other people are saying 40 years after Roe v Wade:

Happy Birthday to Roe v. Wade—What's Left of It

Forty years after Roe v. Wade, most under 30 don’t know case was about abortion

Roe v. Wade at 40: Most Oppose Overturning Abortion Decision

Roe at 40, in 2 Charts

Abortion poll: Keep Roe v. Wade

If Roe v. Wade Goes

Recalling the world before Roe v Wade'


Resources / Take action:
ACLU's list 
Unitarian Universalists (UUs) list

PS totally frustrated that when researching events and articles for this post, the anti-abortion movement has a FAR greater amount of content online (as least in a google search) than the pro-choice movement.  Arg!!! 

Full circle

Pesach is over.  How did that happen?  I blinked (and cried) and the week flew by.  Clinical duties, studying, break ups, and the rest of life very much got in the way of observing the holiday with true kavaneh this year.  Instead of "next year in Jerusalem", this year I'm saying "next year with more kavenah and ruach."

This weekend I'm presenting at an activist reproductive rights conference. This annual conference is where I got my start.  This is the place where I decided I wanted to be a doctor and an abortion provider and where I learned to be an activist and advocate for the whole complex plethora of women's health issues.  It is somewhat surreal being back here, surrounded by old familiar faces and young bright-eyed budding activists, coming full circle with my roots.  It is also re-energizing.  I'm filling my senses with everything reproductive health related.  Currently I'm fixated on unpacking an amazing workshop I went to this afternoon on "pink boys": how to break down gender binaries in education, how to parent non-conforming children, the importance of media literacy, and so much more.  Hopefully, if I successfully process all that I learned in those 2 hours, I'll be able to post more about. 

In the meantime I'm going to do a few psych questions and then crash for the night.   Life as a medical student: studying trumps all, even when I'm away at a conference, even when I'm reliving my good ol' college days.

Another MD voice in the conversation

I really appreciated reading "Rated R, or perhaps NC-1" over at gravity circus.  She's pretty wonderful and also someone I'd be more than happy to have as my own doctor.  I believe that the more medical voices are out there in this conversation, the better.  

Dear Doctor Anonymous,

Thank you.  Thank you for this post on state mandated transvaginal ultrasounds.  Thank you for expressing your outrage so eloquently in writing.  Thank you for remembering that the patient is the one and only priority in this equation.  Thank you for remembering your responsibility to your patient as their physician. 

As a patient, I hope that all physicians I see are like you, focusing on evidence based medicine practices and not on conservative politics.  As a future physician, and a future provider, I hope to be like you.  I pray that I don't forget the power of my actions, a problem that I have seen some physicians fall victim to.  I hope that, like you, I can keep my patients in the focus and remember that a little civil disobedience can go a long way when necessary.

Thank you,
me

update: A friend pointed me to another article

'We Have No Choice': One Woman's Ordeal with Texas' New Sonogram Law posted in the Texas Observer on March 15th, that is very much worth the read.

The line has been crossed = time to protest!

This political attack on women's bodies and personal medical decisions has gone too damn far.  It is one thing when Mitt Romney takes a stance to defund planed parenthood if elected president; while far from desirable, no one is in immediate danger.  However, it is totally crossing a line when state legislators vote on whether a doctor can straight up lie to his/her patient in order to ensure she doesn't opt for an abortion. 

This all seems way too similar to the ethics lecture I recently heard: "Deadly Medicine in the Nazi Era: What Turned Physician Healers into Killers?" (this article touches on some of the factors that were discussed in the talk).   The idea that doctors are following this moral extremism with disregard for reality, not realizing or not caring that their moral belief is directly harmful to their patients... so damn scary what power and knowledge in the wrong hands can lead to.

Anyhow, I'm more frustrated at the politicians who we are currently paying to sit in office and debate away our right to choice, education, and honesty.   They are wasting our time and our money.  They are degrading women all across America by belittling us into a category of those incapable of thing for our self.  They are putting us at risk for unplanned pregnancies, incomplete healthcare, and clandestine abortions.  They are personally pissing me off!

What can we do about it?  VOTE.  Get these fools out of office.  However the election is a little while away so in the meantime there is a National Protest Against the War on Women being planned for April 28, 2012.  Taken from facebook:

National Protest Against the War on Women
Saturday, April 28, 2012 
10:00am until 2:00pm
State Capitols in all 50 States and DC
Join our organizing page: http://on.fb.me/wBUDYu

Organize your friends and go take a stance!  For the medical students and professional out there, please please please wear your white coat when you do.  It makes a difference for people to see that we're fed up with this BS.

Repeating history

Due to a conversation today on state and federal healthcare spending, which quickly derailed into a conversation about all the issues with the federal budget, I've been thinking a lot about this whole "occupy wall street" thing.  John Stewart's "Parks and Demonstrations" shtick has fueled this thought process.  What if this is the real deal?  Could this be the start of something big?  A slowly growing revolution creating the change that is needed for sustainability and success?

It reminds me of all the stories I heard about the Vietnam era.   Stories of organized dissent, public protesting, empowerment of the younger generation.  These were stories I used to ask my parents to tell me over and over when I was little.  I always found myself a bit disappointed that they had such passive roles, envious of friends' whose parents were at UC Berkley and the such at the time.  They weren't the sit-in hippies or the draft dodging rebels.  They were just run of the mill 20-somethings, doing the best they could to stay on their feet, trying to progress their lives while barring witness to history evolving.

If this is the real deal, I imagine the conversation I will have with my future kid(s), G!d willing!
Kid: Mom, tell me about the wall street take over!
Me: Well, I was a 3rd year medical student at the time, busy on the wards and really out of touch with what was going on...

Hell in a handbag

I'm feeling both overwhelmed and depressed about the current state of women's rights in politics. Rachel Maddow explains it much better than I can. I've been doing as much local protesting and organizing as I can, but honestly, I'm currently feeling defeated. That no matter how hard I hold on, my rights as a woman and as a future medical provider are slipping from my hand. But I can't stop fighting. It is a lot easier to continue to hold on than it is to try to get rights back once they have been taken from us. Plus, I can't turn my back on my grandmothers and future daughters/granddaughters. The generation before us fought so hard in the first place to make ab. The generation below us, growing up without comprehensive sex ed, will inherit the mess we leave them with. It is our responsibility to guard the present, to ensure American women the right to safe and legal abortions.

It is also our responsibility to make sure that future providers (myself included) continue to get the training necessary to ensure access. The US house of representatives is currently trying to put make training even more difficult than it already is. They passed a bill on Wednesday, the Foxx amendment, to ban teaching of abortion in federally funded residency programs. Since all residency programs are federally funded, this basically means even less training will exist. Keep in mind that the list of programs that teach abortion training is already very short. My point is that you should call your senator. Or write them. Or both. Tell your friends too. Please, I beg you, do your part to make sure that the Fox amendment dies in the house. I don't want to be a doctor that has to sit ideally by watching my patients die from botched abortions simply because the US government put too many hurdles in the way of my training.

A glimer of hope?

It seems that the Senate Republican's are being a little more rational than the House was with regards to title X (planned parenthood) funding. In today's news from National Partnership for Women and Families, the following was stated:

"In a letter to Senate Appropriations Committee Chair Daniel Inouye (D-Hawaii) and Vice Chair Thad Cochran (R-Miss.), Sen. Lisa Murkowski (Ala.) wrote, "I believe Planned Parenthood provides vital services to those in need and disagree with their funding cuts in the bill. ... I ask you to consider these programs going forward to determine if there is room for allowing continued funding."

In a separate e-mail to a constituent, Murkowski wrote, "I do believe that Planned Parenthood provides vital services to those in need and disagree with its funding cuts contained in the H.R. 1 package." She added, "From 2002-2008, Planned Parenthood received $342 million in federal taxpayer money through Title X funding alone. With these funds, Planned Parenthood has provided women throughout the U.S. with important family planning and contraceptive services as well as screening for breast and cervical cancers for low-income women. I believe it is important that Title X organizations continue to receive funding."

Sen. Susan Collins (R-Maine) last week also announced her opposition to eliminating Title X (Politico, 3/11)."

We need to keep fighting this as it hasn't been voted on yet. Continue to contact your elected officials, continue to spread the word and raise awareness, continue to take a stand for access to reproductive health care.

Continuing Involvement in Social Activism and Jewish Life

Yesterday evening I took a study break to sit on a panel about "Continuing Involvement in Social Activism and Jewish Life". There were 6 of us on the panel; all Jewish young adult involved in multiple different forms of activism. Besides me there was a lawyer, a social worker, a teacher, a independent journalist, and even a pet sitter. We all had different backgrounds, different interests, different relationships with our religious identity, and different words of encouragement to share.

Like all good Jewish events, the night started with a text study. We then were each given 8 minutes to answer the following questions: 1) Introduce yourself and describe your initial service experiences and your transitions since then. 2) Describe your path of continued involvement in social activism. 3) What insights have you found about yourself as an agent of change? 4) In what ways have Jewish values and/or the Jewish community been part of your “work?” 5) Share a story about a time when you knew you were making a difference? Then we split up around the room, and met with participants who wanted to ask us individual question.

This was the second such panel I've participated in since starting medical school/moving to this southern city. Both times I have left feeling completely energized. Through the retelling of my own story, I am afforded the opportunity to see how far I have come on my journey, to see that besides set-backs I have had significant successes, and reflect on how much work I am currently doing [even as a busy medical student]. It allows perspective to see the unexpected doors that opened, and realized that things work out in their own unique way in spite of how much I antagonize and plan. One of the other panalists explained how he became an activist the day he shifted his perspective away from living life by "checking off boxes". Another stated how her activism is accentuated through humility of her own weaknesses and through learning from her clients. A third talked a lot about self-care. I am pretty sure that while I gave out insight and advice to the participants, I walked away with much more from the experience than I gave.

And to inspire you to keep fighting, here are some inspirational short videos.

Passing of the tourch

Since coming back from winter break, we second years have been working hard to hand off our extra curricular responsibilities to the first year medical students. The theory is that by starting so early we are allowing for a bit of transition before we fully disappear into step 1/clinical rotation land. The reality is that most of us just want to play a game of "ding dong ditch" with some of these things. Yes, they are causes that I'm passionate about, and leadership roles that I really appreciated having this year; but my current priorities have shifted to 1) staying sane, 2) doing well on step 1, 3) staying sane. Staying sane, which involves eating health, sleep, exercise, and a bit of socializing, doesn't leave much time for running 2 student groups, doing research, and involvement with major amounts of grassroots organizing.

The problem is finding first years who are idealistic and naive enough to take on these responsibilities. Just as we are trying to hand them off, their work load has increased... scaring them out of taking on too much. Last year, I hated hearing my class referred to as "slackers" for not wanting to take on leadership roles. So I am trying my hardest not to be frustrated with the current first year class for their lack of eagerness to take over all of these wonderful opportunities. I do get it. But PLEASE, take my positions! I want to be done with them already! I want to disappear to step 1 land foot-loose and fancy-free!

The revolution will not be televised

I'm beyond frustrated with politics in our country. While we are a very diverse country with very diverse views/morals/ethics, violence is NEVER the answer. Hopefully we can all agree on this. Hopefully we can use the tragedy that happened yesterday as a spring-board for anti-violence campaigns. Rather than simply saying "it's a pity" and then returning to our normally scheduled lives, let us not stand idly by in the face of the unacceptable. Let us teach our children about the power of hate and evil speak, and then through our own actions we can teach them that they too have the power to stand up against this type of behavior.

What I'm currently fixated on though is the House's desire to repeal the health care reform bill. How is this productive? Effective? Are we seriously going to waste time tying up the legislator with silly political games instead of getting shit done? Oh, and waste tax payer's money in the process too. It is not like the repeal will get by the Senate, or even if it does, that Obama will approve it. Fine, I admit, I'm a STRONG believer in health care reform. I DO believe that health care is a right (not a privilege) and that our pre-reform system of health care was on a crash course towards crashing. Not only was it doomed to eventually fail, it was accelerating on it's trajectory in the process. Way too much of our GDP was going towards health care and the money being spent did not reflect the quality of care being offered. Why do we spend far more than any other developed country and yet have some of the worse health care available? So yes, I will not deny that I am biased and I am pro-health care reform.

In short, I'm angry. I want to know what I, as a medical student and as a concerned citizen of The United States of America, can do to take a stand? How can I do my part to make people realize how important health care reform really is? What kind of national movement can I, along with other concerned citizens, start to ensure that our voices are collectively heard? That we want politicians to stop playing childish games and start actually fixing the problem!

Earlier this year Dan Savage had an idea to take a stand. Out of his inspiration the "It Gets Better Project" was born. Why can't we do the same? Why can't we create a national movement to support health care reform? Any ideas on how we can start our own grassroots movement would be greatly appreciated. If someone else out there is bouncing around some idea in your head about how to do this, stop thinking and start doing! If you do, I promise to be standing proudly beside you!

Living in the south is bad for women's health...

The National Women's Law Center in conjunction with Oregon Health and Science University published the "2010 health report card for women" today. This report card looks at all factors important to women's healthcare: access, family planning, abortion, wellness & prevention, policy, etc.

The first thing I did was to look up the state I currently live in: F. Then I looked up the states that surround me: F, F, F, F... The south (TN, KY, LA, AB, MS) = fail. While not at all surprising, it is beyond frustrating. We theoretically live in a rich country with access to some of the best healthcare in the world; except clearly not. Women should not be receiving inferior care based on their gender. Southern's should be at a disadvantage based on their geographic location. Aren't we all US citizens?

My very liberal view is that we need some serious healthcare care reform NOW. Bring on the universal care with a single payer plan! Bring on preventative medicine. Bring on health education. Better incorporate other professionals into a person's care plan: social workers, nutritionists, and the such. Integrate more reproductive health care into primary care. OR, I should just move to Canada, or England...

What is my role in all of this? How can I help to improve healthcare as a medical student? Should I be getting more involved in health policy? How can I better prepare myself to provider comprehensive healthcare in such a broken system?

Words of Choice

“What is a good and RATIONAL reason to have a baby?"

This question was posed to us at a really wonderful “Words of Choice” workshop, which I had the opportunity to attend at this weekend’s conference. The workshop was facilitated by Joan; a well spoken, spunky, experienced, and passionate activist who shared insightful wisdom. With her blessing, I’d like to pass on a brief cliff-notes version of some of the thoughts and practical ideas that were presented. Please note that my writing cannot actually give this workshop justice.

The follow-up to the above question: It is pretty difficult to determine rational reasons to have babies. So, why do we expect such reasons from those choosing to not be pregnant?

General advice we were given about responding to anti-abortion rhetoric:

-Take a deep breath and then speak on the out-breath; this will lower your voice, giving you more authority. It will also help to keep you calm.

-Give a fact and move on

-Briefly state personal opinion

-Offer a generalized statement to recognize the complex philosophy

-Agree to disagree

Drum roll for my favorite piece of advice….

–Instead of holding tension in your back, shoulders & neck during these interactions, do kegels! Improving your sex life totally beats a life of stressed induced back pain.

Specific ideas that were suggested to respond to rhetoric with:

-“Women regret abortions” --> “Any major life decision has the possibility of regret -why should this one be different?”

-“You’re going to hell” --> “I’ll see you there”

-Someone making a threat on you/your family -->“What I am doing is legal, threatening me is not”

-“What if your mother had aborted you?” --> “Then I wouldn’t be standing here dealing with you”

-“Baby killer” --> “I’m proud to offer this service, babies are too important to be an accident”

-“Why is the mother more important?” --> “The mother already exists, and a child needs a strong & ready mother.”

Some other comments:

-"My concern is for the living children in this world who aren't getting their needs met. That’s where I would rather focus my energy.”

-“I didn’t go into this [providing abortions] to become a judge, therefore woman’s well thought out choices are all valid to me”

-“If one believes that the soul is immortal...then for the soul, having an abortion is like missing the bus - the soul will wait around for the right woman to carry it when the time is right.”

-“Human life is too important for there to not be choice present.”

One of the best parts of this workshop, which I can’t sum up here, was the opportunity to think/talk through my own ideology in a safe space. I recognize that my opinions, experiences, and beliefs will develop as I continue on this path to becoming a provider. (They already have shifted a bit over my past year and a half in medical school.) I recognize that in order to allow for this growth and ensure that I don’t burnout, having these safe spaces are so important. Besides being grateful for the overall session, I’m super excited about all the kegels in my future!

Where is the line?

I've been thinking and talking a lot about abortion today. Day dreaming about women's reproductive health isn't totally uncommon for me, but because of the Med Students for Choice national conference I was at this weekend, it is especially on my mind. The conference was such a high. A total reminder of why I was drawn to medicine in the first place, what I hope to accomplish in my career, and that there is a world of like minded peers out there (even if I am separated from the majority of them by the Mason-Dixon line).

I have so much I want to tell you about the conference. I took notes during the workshops which include many ideas for blog posts scribbled in the margins. These posts will (hopefully) come in due time. Once I have finished processing, caught up on sleep, and no longer feel like I am drowning in renal pathology. Okay, okay, maybe I wont wait that long; but I am not yet ready to post about it all tonight.

In the meantime, I received a gchat message from a classmate today. A classmate that is very much a friend. This was the message: "http://www.makearightchoice.com/index.htm
that's an interesting website i found in my research. thought you might want to take a look. "

I can't tell what his intentions were for sharing with this me. Was this in response to my attending the conference? Or did he really just want to bring it to my attention that such websites exist? I am (pretty) sure he didn't mean it to be threatening or an intervention, but regardless of the intentions, it still stung a little. This is someone who I deeply respect, conservative views and all. We dialogue about our opinions, we agree to disagree, and we normally are very respectful of the other's perspective and ideology when interacting. However, intentional or subconscious, I feel that this crosses a line. This plays into my fears about the path that I am on. Regardless of my fear of overt or subtle harassment, I WILL NOT stop being an advocate for abortion and I WILL continue on my path to becoming a provider.

election day 2010

I voted! Did you? If you didn't, why the hell not?! How can you rationalize silencing your own voice? I don't care if you're apathetic, too busy, confused as to who to vote for, etc... it is your damn civic duty! While one little vote doesn't seem like a lot, what would happen if EVERYONE decided that their vote was worthy enough to be cast? So get over yourself and step up to the challenge. Vote. VOTE! Vote as if your life depends on it. In fact, your life (or at least the way you live in this country) may in fact depend on it.

Nothing compares to election day 2008. I spent the day on a med school interview in the Northeast. The interview went well, and I was excited by the political buzz surrounding me on the very liberal campus. The interview ended, I changed out of my suit in the parking lot, and began the long drive home all the while listening to NPR. I drove through small town after small town, each sporting a very different set of political propaganda. Driving across New Hampshire I counted signs to see if I could discern which way the state would swing. I arrived home to a house full of people anxiously awaiting results to come in. We were having an election night party. My housemate directed me to the stack of mail, where I found my first acceptance waiting for me. Getting into med school was the first victory of the night. A night of many small victories communally experienced in my cozy community. My high was grounded the next morning with the announcement of prop 8, but for one night I really believed we had the power to conquer the world.

I'm pretty sure I'm not going to be happy with the results of this election. I'm not yet sure what exactly I'll be unhappy about, but it isn't looking so good. It is looking even worse from my vantage point way down South in conservative land. I miss my cozy and loving community. I wish I were with them tonight. Such is life. You win some, you loose some.