Mother's Workplace Discrimination in Medicine and Industry

It’s a sad reality that, at present in the U.S., women face workplace bias when it comes to pregnancy and caring for their babies.

On 12 December, 2018, there was a sobering article in the British Medical Journal:

Physician mothers’ experience of workplace discrimination: a qualitative analysis by Meghan C Halley and colleagues.  Link.

and on December 21, a similar piece appeared in the NY Times:

Planned Parenthood Is Accused of Mistreating Pregnant Employees:

Employers that champion women face accusations of discriminating against their pregnant workers, showing how widespread the problem is in American workplaces. Link.

 We are sure that women reading this post will have stories of their own.  Please feel free to comment. 

Note: "The United States, Suriname, Papua New Guinea, and a few island countries in the Pacific Ocean are the only countries in the United Nations that do not require employers to provide paid time off for new parents." Wikipedia

Beware of Dr. Google

Haider Warraich, NY Times, December 17, 2018  Full Article

It appears that “fake news” isn’t restricted to the political realm. In a New York Times Op-Ed essay, cardiologist Haider Warraich discusses the alarmingly high amounts of false medical information on the internet. He describes how this deceptive material (which stands out through eye-catching titles and dramatic claims) often emphasizes the often very small potential risks of evidence-based medicine, dissuading individuals from taking needed medications and receiving vaccines. Patients will continue to search for health information on the internet as doing so is rapid, cheap, and anonymous. But how do we ensure that they are presented with accurate material?  -- Benjamin Wipper.

Haider writes:
"While misinformation has been the object of great attention in politics, medical misinformation might have an even greater body count. As is true with fake news in general, medical lies tend to spread further than truths on the internet — and they have very real repercussions." Full Article

Unnatural Childbirth in America

Two recent reports highlight some of the challenges women currently have at the time of delivery.

1.  While many, perhaps most, women prefer natural child birth; the reality is that in many parts of the United States the C-section rate hovers at or above 50%.  Why NY Lags So Far Behind in Natural Childbirth (NY Times 11/20/18) is a comprehensive discussion of this subject.

2. VBAC (Vaginal Birth After Caesarian) has been touted for at least thirty years.  NPR had an interesting segment devoted to this topic recently: Twin's Difficult Birth Put A Project Designed To Reduce C-Sections To The Test.

Amy Sosne, M.D., a physician and mother, comments both of these pieces.

Revelations in a Wheelchair

In late 2001, I heard Daniel Gottlieb, a psychologist and best selling author, talk about an experience he had while waiting in the hallway to give a keynote lecture at a prestigious conference. Gottlieb had been in a serious accident years before and was left quadriplegic. He was sitting in his chair outside of the lecture hall, a coffee cup resting on briefcase on his lap, looking down at his notes. A woman walked by, eyes averted and thinking that he was begging, put a dollar in his mug.
 

Nolan Ryan Trowe tells a similar story in an Op-Ed piece in the Sunday, November 25, New York Times entitled: “Revelations in a Wheelchair: A recently disabled New York City photographer gets an education in the discrimination that people like him must face.”  You may find it worth reading.

An Introduction to Trauma-Informed Care

Two short Perspective pieces in the November 20, 2018 NEJM are excellent introductions to this subject.  They discuss how we, as health care providers, can serve our patients better.  Significant numbers of our patients were victims of violence that informs their general health.  This is a huge, underappreciated subject that we do not think enough about in our rush to get through our busy clinics.

1. Trauma-Informed Care - Reflections of a Primary Care Doctor in the Week of the Kavanaugh Hearing. by Eve Rittenberg. N Engl J Med. 2018 Oct 10.  Free Article

2.  Sit Back and Listen — The Relevance of Patients’ Stories to Trauma-Informed Care.  by Dorothy Novick. N Engl J Med 2018; 379:2093-2094 Free Article

Excerpts:

Rittenberg:

“I am a primary care internist, practicing in a women’s health group. My patients’ experiences reflect the prevalence of trauma in our country: more than one third of U.S. women have been the victim of contact sexual violence at some time in their lives. Sexual assault often starts early — 40% of women who have been raped were first raped before 18 years of age.  In my work, I have the privilege of being present for women who share with me their fears, their hurt, their shame — and trust that I will stay with them and listen

“Health care providers have an opportunity and responsibility to dig deep into ourselves and commit to actively resisting retraumatization, to develop the resources to support survivors, and to support each other as we do this work.”

Novick:

“If there is one thing I have learned over 22 years of practicing pediatrics in an under-resourced urban environment, it is that patients reveal their most personal and painful life experiences when we build trusting relationships and encourage open dialogue. The more we understand about the long-term effects of toxic stress due to adverse childhood experiences, the more important it becomes for us to absorb these stories. They form the crux of trauma-informed care.”

There is also an informative eleven minute online interview with Eva Rittenberg on providing patient-centered and compassionate care for people who have experienced trauma that can be accessed at either of the above links.

Sexual trauma is just one of the Adverse Childhood Experiences and Traumatic Events that result in victims' poor health and shortened longevity.  The ACE Pyramid is a useful summary.

Are You Well Controlled?

by Judith Hendley, BMJ, 11.23.18
Language can convey meaning and shape understanding. It can stigmatize and label or it can empower and affirm.  Therefore, Ms. Hendley would like to be identified as a person first and not as a “diabetic patient.“

As healthcare professionals. it is important to think about the language we use when referring to or writing about people with long term conditions such as diabetes.  We must consider if they would find the language we use in referring to them empowering or disempowering?

This brief but spectacular essay is applicable to many conditions or situations that we encounter in the persons who consult us as physicians.  See: "Are You Well Controlled?"

Doctor Sahib

by Saruabh Jha

New England Journal of Medicine 11.22.18

There was a time when doctors knew their patients and their patients’ families. Medicine, then, was not a team sport: the buck ended with the GP. Saurabh Jha’s  essay about his father in the New England Journal of Medicine is brilliant reminder of a time that has, to a large extent, disappeared.

His physician father in England understood his Pakistani patient “not just because he was fluent in Urdu: as a migrant himself, he understood that most people from the Indian subcontinent  - Muslims, Hindus and Sikhs alike -  don’t see doctors unless they are  ill and don’t take their medications unless they have symptoms."

His father’s “patient trusted him because he believed my father genuinely cared about him.”

This is a moving piece that many of you will appreciate.  Link to Doctor Sahib.