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!!! 

[More] pretty colors highlight [more] sad truth.

Similar to my previous post, Pretty colors highlight sad truth, another chart has been created highlighting the dispersion of rights across the United States. 

Image taken from"Gay rights in the US, state by state", Guardian in America interactive team, guardian.co.uk, Tuesday 8 May 2012 11.12 EDT at http://www.guardian.co.uk/world/interactive/2012/may/08/gay-rights-united-states?fb=native.


This chart is really cool.  The whole article is.  It is interactive, allowing for stratification of rights based on location and specific laws.  It totally brings out the nerd it me. 

Amendment 1 in North Carolina today means that one more state refrains from lighting up.  I certainly hope that, in my lifetime, this whole map fills with bright colors.  I like bright colors.  I also firmly believe that all humans deserve equal rights regardless of who they happen to love.  Yes, being queer does make me bias, but I'm pretty sure I'd feel this way regardless.  Even the [very mainstream / sometimes conservative] American Medical Association (AMA) believes that LGBT rights are essential for optimal health.  Isn't it 2012?

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.

Spoke to soon

So, it turns that just because my state's government is on summer break doesn't mean that reproductive health battles aren't being fought in other areas of the US currently.

According to an article on change.org, "Medical students and residents at the University of Wisconsin pursuing OB/GYN studies may not be able to complete their training -- and the school faces the prospect of losing its residency accreditation for training doctors in this specialty. Why? Because medical students and residents are being banned from learning the abortion and miscarriage management techniques that save women’s lives. Anti-choice politicians in Wisconsin tacked on a provision to the governor’s budget bill stating that state funds cannot be used for abortion care."  Check out the link and sign the petition.

Also, the National Partnership for Women & Families' policy report today highlighted that "Rep. Cliff Stearns (R-Fla.), chair of the House Energy and Commerce Subcommittee on Oversight and Investigations, said the panel plans to investigate the Planned Parenthood Federation of America and "possibly" hold a hearing on the group's federal funding."  Really?!  With soooo much of a national debt to overcome, we're wasting chasing after PP.  Besides the fact that I strongly believe Planned Parenthood deserves every cent of federal funding they receive, blocking $70 million in funding is not going to make a dent in the amount that needs to be cut from the federal budget.  Dearest republican party conservatives, can you please just get over yourselves and actually spend time on things that matter, things that will actually improve the health and welfare of Americans' lives?

Being a lazy activist

I don't really have the time or energy right now to touch on current events in the way I'd like.  Due to step studying, I barely know what is going on in the world outside my window.  [Luckily, state congress is on summer break so access to reproductive health is not overtly being stripped away while I hide away inside.]  But, I wanted to lazily share a few recent [AMAZING] news articles, all of which happen to be from The New York Times. There was "First Study of Its Kind Shows Benefits of Providing Medical Insurance to Poor" published on July 7th.  There was an absolutely brilliant, and light-harted yet equally heavy piece,  "The Good Short Life With A.L.S." about how we face death in our society- really hitting on the need for open communication throughout one's life.  "New for Aspiring Doctors, the People Skills Test" takes a critical look at how medical students are screened in our country, and what some schools are doing in hopes of finding applicants with more people skills.  I personally hope that my own medical school would adopt such innovative interviewing methods.

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.

I'm speechless...

Since I can't seem to process all that is happening [with regards to politics and women's health] as quickly as the Republican party is moving, here are some amazing voices speaking out about the issues:

-The lovely Rep. Jackie Spears speaking out on the floor of the house.
-Another medical student, tackling the issue within her own religious and world view.

I'm scared to see how much more women's health will suffer so that politican's can feel satisfied with their own [male genitals]...

Rethinking meat

I'm seriously considering going vegetarian (again). At 13 years old I went vegetarian as a first step in wanting to be kosher. I continued to eat kosher fish, but gave up all other meats until I was 19 years old. When faced with kosher turkey at a friend's thanksgiving dinner in college, I excitedly gave up my vegetarian identity, opting instead to do my best to find "happy" kosher meat (knowing where it comes from, free-range, etc).

While in London over winter break I started to reconsider meat. After going to a few different shiurs on kashrut I started to seriously think about what being kosher means to me. I also started to grapple with the fact that it is VERY difficult to find local/ethical kosher meat, and that killing an animal in a kosher way may no longer be the quickest/most humane way to do it. Then, today, I unintentionally ended up watching Oprah's episode on going vegan. As part of the episode, Lisa Ling goes inside a slaughter house to show the process. I think that watching those few minutes of footage were enough to get me to go vegetarian again.

I'm not saying that eating meat is wrong or that we, as humans, shouldn't eat meat. Nor am I saying that you, dear reader, shouldn't eat meat. I'm just not sure that I should keep doing it. Watching the way the cows were being processed reminded me way too much of gross anatomy lab, a class that I was VERY uncomfortable with for so many reasons. I realized that given the choice, I would never choose to slaughter, skin, or butcher a mammal in order to consume it. I'm barely comfortable taking raw meat out of the package in order to simply cook it! I strongly feel that I have no right to eat something that, in its entirety, makes me this uncomfortable. Vegetables, tofu, even fish; these are all things that I will take ownership of destroying for my own nourishment.

This is not a decision I am going to make lightly (this time around). So for now all I can definitively say is that I'm in the contemplation stage of returning to vegetarianism.

High school flashback

A friend shared this YouTube video with me today. While I deeply wish that we lived in a world where these types of speeches didn't have to happen, I'm am so inspired to know that there are youth out there like her. This young woman, Kayla, is articulate, passionate, and heart-breaking to watch. I have no doubt that (if she chooses to) she will help to change the world. Her struggle with self-realization, discovering of community, fear of future, and desire to love freely is something that strongly resonates with me. I went through a similar process in high school before ending up in a position much like her: being an outspoken advocate to my peers and the larger community through sharing my personal story. Even still, as much as I've grown into my self over the past 8 years, I still struggle with some of these factors.

Watching the video inspired me to pull out my old high school journal. While there are many pieces of writing touching on my evolving sense of sexual identity, there is one particular piece that strikes a nerve for me. It so strongly reminds me of who I was at 16 along with my fears at the time. It gives perspective on how far I've come, and also kind of excites me to see what changes the future bring.

Written at 16 (in Fall 2000):
"To be scared of the truth, that is only normal right? But what if the truth can change things? What if it changes the way people see you? The words that people use to describe you? What if it changes how people look at you? Or how they touch you? And does it really change things this much, or something you just fear. What if your initial instinct is wrong, and after all the trouble you are only 'normal'?

You see, it has been a big summer for me. A summer of self discovery and of experimenting. A summer of pushing the limits I had already set up for myself and of testing new unguided territories. But the summer has quickly ended leaving me uncertain and in new worlds. For the first time in my life I have a girlfriend when all I have ever imagined were boys. I'm now explaining to trusting friends that I am Gay, something that I'm not even sure of for myself. They all react the same way though; they all told me that they already knew, which only leads me to question myself more.

But summer has ended, and to go back to my old ways of life isn't as easy as I had hoped. What if people know? Will it change the way they see me? I'm used to hugging my friends and kissing them on the cheeks, will that stop? Would the people I'm used to cuddling with at [youth group] events be scared away if they knew the truth? It scares me, why wouldn't it scare them?

I know [youth group] is supposed to be a safe and accepting environment but when people use terminology like 'oh, that is so gay' and when they address people as 'fags' for being outcasts, how am I supposed to know what affect it would have on the way I am treated. And what happens when everyone is either hooking up or talking about their relationships at home, am I supposed to say 'yeah, I have a girlfriend' and well, come out of the closet to people I don't know so well when I'm not even sure if I'm in the closet?

But like everything else time will tell. The event will come and go and people will probably never find out. I'll hug and cuddle and just wonder what they would think if they knew the truth, and I will wrestle with the thought of being Gay in my own mind. In the end I will fall in love with the person I fall in love with, not with the sex of the person, and feel foolish because I pus so much time into trying to put labels to feelings that shouldn't always be defined."

Cool as a cucumber

Yesterday, my preceptor (a 3rd year resident and really wonderful teacher) was telling us stories about his med school psych rotation. He explained how he was at an inpatient hospital and saw the crazy-of-the-crazies. He gave us a few patient vignettes, each one crazier than the one before. We were wide eyed listening, with growing excitement about the possibilities of our future psych rotations.

And then, "There was this one woman who thought she was a man!" Crash! Back to reality. Back to remembering that I am a medical student in the conservative South. He went on explaining the case, and when he got to a natural break, I spoke up. "You know they're in the process of removing gender identity disorder from the DSM?" I did my best to stay calm. To engage in a rational discussion about shifting understanding of gender identity. He tried to justify his comment and then quickly moved on to "And then there are narcissists! I had this one patient..."

It isn't his fault. It wasn't malicious. Even though he is a young doctor, he had never learned otherwise and so he was just passing on what he knows. This was a perfect case study in why medicine is a slowly evolving profession. But regardless, it is also a little heartbreaking. A sharp reminder that there is so much work to be done in this world. That the most effective way to do this work is to stay calm. To be cool as a cucumber. Slowly, I will rationally and politely educate my professors and peers one person at a time.

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!

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!

Dr. Harrison

Dear Dr. Harrison,

I was fortunate enough to hear you speak last fall when you visited my southern medical school. As a first year, I sat wide eyed listening as you eloquently explained your motivations to provide comprehensive women's health care, your drive to ensure that all women have access to safe abortions, and the factors you have had to overcome in order to offer these services. The stories you told of the patients you have encountered inspired me. I have no doubt that these patients, and so many more, are standing with you now in solidarity.

I spoke with you briefly after the presentation, asking if it is better to do the MSFC externship between first & second year vs. during 4th year electives. Along with replying that 4th year is preferable you also suggested that I should come to your clinic to do it. As someone struggling with the conservative nature of my school's OB/GYN department, that warm and welcoming invitation is something that I will always carry with me. It is a rose among the thorns of naysayers and hurdles trying to keep me from being trained as a provider. Just as you did not hesitate to offer yourself as a teacher and mentor, I promise to never hesitate in pursuing my education. In following your lead, I will not let obnoxious barriers keep me from providing safe and affordable care to women in need.

Thank you for all you have done. Thank you for believing in women's rights, and for letting these beliefs shape your actions. Thank you for being a warrior on the front lines. Thank you for inspiring all of us future providers. Thank you for paving the way for me and my peers to be abortion providers, to be guardians of women's rights, and for showing us that we can actively model our values and beliefs. You are leaving us with mighty big shoes to fill. While we might not be able to fit in them perfectly, I can promise you that we will continue to march on. Your patients need us to, the women of Arkansas need us to, the women of The United States need us to, as well as the rest of the women in this world.

While the words will never be big enough, they are the best I have:

THANK YOU FOR ALL THAT YOU HAVE DONE,

(just another MSFC member and future abortion provider who is inspired by you)

going gay

My medical school went gay last week.

Okay, fine, let me try rephrasing that. After a lot of work, meetings, and jumping through hoops, we finally got an LGBT and allies student group approved at the medical school. While not as hard as I feared it would be (and with a lot less backlash) this was still a rather difficult task as we had to defeat the overwhelming amount of stress induced apathy. But advocacy and grassroots organizing paid off. We are now a guaranteed student group with all the rights and privileges such a status bestows... all $300 or so a year to put on events with, events we were already putting on. The money wasn't the point of creating a student group though; rather it was to create a visible and inclusive community fully supported by the administration.

To celebrate we had a gay happy hour outing Friday afternoon. There was an excellent turn out and people seemed to enjoy themselves. Meeting some of the first years was lovely. The surprise of the night? Learning there are nearly 15 openly (out) identified (L/G/Q/insert proper identity term) students in the first year class. That is as many as the other 3 years combined! While it still represents less than 10% of their class population, it is a HUGE number for a medical school class, especially medical schools in the South. I'm taking it as a positive sign for the ability to change the system and encouragement to keep fighting for LGBTQ visibility. I'm also really interested to see if this increase in population will have any effect on perceived community dynamics. Or for that matter, on my personal life (so doubtful)....