My Privilege Triggered TSA Action

(by whizbang) Nov 25 2015

Drugmonkey has a series of vignettes he uses to launch a discussion of privilege and disparities in NIH funding. The first of these reminded me of a recent event in my own life. Briefly, it involves a guy with TSA PreCheck status who gets a secondary bag search and the dude is SO INCONVENIENCED.

If you fly more than occasionally, the TSA PreCheck rocks. You take your passport to a center where you get photographed and fingerprinted. After a background check, you are assigned a known traveler number that you enter when you book an airline ticket. The security line is generally shorter. You pass through a metal detector instead of the scanner. You still run your bags through the x-ray machine, but you can leave laptops and CPAP machines in your case, as well as your bag of tiny liquids. You still only carry on 3.1 oz bottles in a sandwich baggie, but you don't have to dig everything out and repack. You can also leave on your shoes, unless they set off a metal detector. I would like to thank Tory Burch for putting so much metal in the logo on my ballet flats that I still get to wander through barefoot. All things considered, my PreCheck status is well-worth the $85 I paid for 5 years of facilitated screening. For my travels, that works out to less than $1.50 per security screen.

This last return trip, my purse got a secondary search. They had looked at its x-ray for a long time, so I knew something had piqued their curiosity, but I had no idea what it might be. I had added nothing since my uneventful screening en route to Baltimore.

Here is the culprit:

Expensive but gorgeous; click to Sephora

Expensive but gorgeous; click to Sephora

Apparently they had not seen Louboutin's lovely lipstick before. It costs enough and it's new enough to make it scarce in the TSA world (it's clearly a symbol of my socioeconomic status and privilege). They handed it to me and had me show them how it worked.

I am glad that they take screening duties seriously, even though I am sure they felt a little silly making a fuss about a lipstick. The whole thing was pretty hilarious to me, and it barely slowed me down. Finally, I'm so grateful to not unpack laptop, liquids, and that damn CPAP machine that I can handle occasional nonsense like this event.

I hope the people Drugmonkey documents can learn a lesson from their experiences although I doubt that it happens. If you have not read his post yet, what are you waiting for? I'll even put the link here again, just in case scrolling up to the first paragraph is too inconvenient.

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Thoughts on Race and Ethnicity in Medicine

(by whizbang) Nov 23 2015

I'm listening to a discussion on NPR's On Point about mixed race in America. I recommend reading the website and listening to the discussion.

In medical school, we teach our future doctors to put the patient's race right up front.

"X-year-old-Race-Gender person with a chief complaint of bunnyhopping."

How useless.

Race and ethnicity are based on appearance or self-reported, the latter being the gold standard in the clinic. We have no way to confirm or deny someone's identity in an objective way unless genealogy studies are available*.

Even if you believe that race can be important for a patient, how do you factor it in? Do I assess the blonde-haired blue-eyed girl as the white person she appears to be or as the Cherokee that she legally is?

Society at large, like Native American populations, has mixed over time. Even in my career, race has not been as helpful in diagnosis or prognosis as we were led to believe in medical school. I have seen black children with cystic fibrosis and white children with sickle cell disease.

Race and ethnicity matter for health, of course, since they associate with social, cultural, and economic factors that are far more important in treating and preventing disease than the color of skin, the texture of hair, or the shape of facial features. While there may be some genetic risks that segregate by race, we should identify the genes rather than using a poor proxy like race. We also need to be an inclusive society for people of all identities to minimize some of these social, cultural, and economic factors that segregate with race and ethnicity (hey, I can dream).

I have quit asking and reporting race in my patient notes. No one is grading me at this point in my career.

That blonde Cherokee girl can get a lot of care through her tribal health center at no cost to her family. Now that's a good thing to know for her medical management.


*And you never know how accurate these are since children may be fathered by someone not on the birth certificate

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Burned Out But Back

(by whizbang) Nov 19 2015

Life has been hectic for several months, full of changes and plans. As pressure built, I felt like something had to give. In my case, it was blogging. After all, I write here as a hobby with no financial reward. The police weren't going to show up if I failed to blog. Even though I use my real identity, I doubted that any readers would grab pitchforks and light torches if I didn't post. I was right about the lack of external consequences.

I was also wrong.

I have felt horribly burned out for a while. Focusing on full-time patient care is exhausting. I need to process thoughts and write to feel whole, even if it takes some time out of my day.

Thanks to everyone who still follows this blog. I look forward to being myself again.

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Travel Time #AAMC15

(by whizbang) Nov 04 2015

Blog1Tomorrow I hit the friendly skies to head to Baltimore for the annual meeting of the Association of American Medical Colleges (AAMC).  Unlike most meetings, this one focuses on non-scientific parts of the mission of academic health centers. Teaching, funding, increasing diversity, professionalism - all will be discussed at various points in the program.

The AAMC has been examining ways to shorten the medical school curriculum, in part to reduce debt burden for new physicians. I graduated from University of Missouri at Kansas City, a program developed to do this from the ground up. Immediately after high school, I entered the program and graduated with both a BA and MD in 6 years. UMKC graduates have gone on to success in all aspects of medicine, including academia and scientific research.

So why hasn't this model of acceleration received more attention?

When a call went out for discussion groups during a luncheon, I put this topic in the hat. I am delighted that it was selected! If you are interested in the 6-year approach or condensing the medical curriculum, and you are at the meeting, please join me at 11:45 am this Saturday in the University Ballroom of the Marriott at Camden Yards. We will be at Table 1.

Yes, I will blog about this and other meeting sessions. Expect live tweets as well.

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Social Media Housekeeping

(by whizbang) Nov 02 2015

I do not use all social media platforms equally. I have set some limits on how and who I interact with on different platforms as follows:

  • Twitter:  Anything goes; this is where I hang out the  most.
  • LinkedIn:  If you want to connect with me, and you do not appear to be a spambot, I will accept your connect request.Some folks in industries not remotely connected to my own have provided useful and unique information.
  • Tumblr:  I do very little on this site, mostly posting photos of Pretty Cocktails. I haven't had a visually unique beverage in a while, so don't hold your breath.
  • Instagram:  Most of my photos end up on Twitter rather than here. You can follow me, but it won't be exciting.
  • Facebook:  I limit Facebook to actual friends - people I know from real life or have interacted with at various venues. I will accept as friends work colleagues because I consider them friends. I try not to friend patients; there are things we should not know about each other. I do have a public professional page that includes posts from this blog and other material I find interesting.

In other words, don't be insulted if I turn you down as a Facebook friend. I just don't know you well enough yet.


Yes, I am on G+ but I have no idea if anyone else is. 

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My Daughter's Vows

(by whizbang) Oct 26 2015

My daughter and her spouse decided to write their own wedding vows, something I generally think should be avoided. The length of her notes frightened me, but she said they would be perfect. She kept going on about sea otters, a favorite animal of hers (although sharks always come out on top), and how could anything with sea otters be bad. With her permission, I am printing her vows here:

Sea otters in the Northern Pacific eat, sleep, mate, give birth, and hunt at sea. They are the only member of the weasel family that can live their lives entirely in the water. At night, you can see a group, or raft, of otters holding hands so they do not drift apart while they sleep. They wrap themselves in seaweed to help keep themselves together. Like these otters I often talk to you about (daily), I give you my hand so we will never drift apart.

Ever since I met you, I knew we would be close. It sounds corny, but I knew right away. I have known you for almost half of my life...I did the math. We have gone to the mountaintops, seen the flat plains, and discovered the depths of the ocean together.

I promise to respect, honor and love you for the rest of our lives. I promise to love you in sickness and health, for richer or poorer, and for all the ups and downs. I also promise to be honest, faithful, kind, and to cherish you always.

Most importantly, I promise to be not only your wife, but your under-average cook; camping, kayaking, and fishing partner; your best dive buddy; and your companion always.

I can't wait to have the next adventure with my best friend.

The groom melted, and that's what matters.

Now, if I ever catch up with work, I will blog about science and medicine stuff!


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Seeing a Specialist

(by whizbang) Sep 23 2015

The next outpatient on my schedule is brand-new to our facility. I have received a referral authorising me to  evaluate and treat, but with no records or indication of the problem. Our check-in process shows normal growth, vital signs, and urinalysis. The new patient form filled out by the family states "my doctor referred me" as the reason for their nephrology referral. The review of systems on the form also reveals no signs or symptoms of problems. I ask the family why they are seeing the kidney doctor, and they tell me their doctor thought it was a good idea.

This presentation makes an initial visit with a specialist less useful than it should be. Trying to identify the issue can take all my detective skills and multiple phone calls. There are things patients can do to prevent this situation:

  • Know why the referral is made, even if you cannot say it in doctor-talk; "blood in the urine" tells me just as much as "hematuria"
  • Get copies of relevant test results, even if your doctor says they will be sent; medical  centers still work by fax machine. Assuming your records get faxed to the correct number, the paper then needs to get picked up off the machine and scanned or filed into the correct chart. Several opportunities for loss or other errors present themselves in this process. Having a copy with you may save unnecessary testing and speed up the evaluation.
  • Bring a list of all medications, including vitamins, supplements, and over-the-counter drugs; better yet, bring all your medication containers.

A bit of preparation can help your specialty appointment go most efficiently. Your efforts can help avoid redundant testing and reduce medical costs. Also, never underestimate the value of making our job easier.

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Long Time, No Blog

(by whizbang) Sep 16 2015

I know, I say this often. I promise this will be changing.

The hummingbirds have headed south, so that shiny distraction is gone.

All my manuscript reviews have been submitted.

My daughter's wedding will soon be completed.

Blogging will once again become part of daily life.

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What I Am Reading: Timely Edition

(by whizbang) Aug 25 2015

Work-life "balance" has become a big issue in the circles of professional women. Can we have meaningful careers and families? Never mind that men do this all the time; society still expects us to run the household and nurture the children, even when we make six-figures. In various career circles, a couple of strategies have been suggested, including "Lean In" (build a career that lets you have the resources to do stuff) and lean out (making part-time work a safer career option).

IKnowHowLaura Vanderkam now presents her work with women making it work. She obtained extensive weekly time tracking sheets from 143 women earning at least $100,000 per year with young children in the home, showing their lives for 1,001 days. She included single mothers as well as those with partners. Some were self-employed while others were in hierarchical companies. What she found will surprise most readers:

  • Most of these women worked less and slept more than they thought
  • Family time approximated or exceeded that reported by more traditional mothers
  • Creative approaches to family time made this possible
  • Housework suffered most, either by accepting "good enough" or outsourcing as much as possible

By looking at a week's worth of tracking data, these women were juggling all the pieces of a complete life while averaging more than 7 hours a sleep each night. They were achieving in their careers and their families were not suffering.

The only criticism I can make is that this work definitely favors the "Lean In" school of life, although she includes women who took the other approach as well. Myself, I am a "Lean In" kind of gal.

I recommend that everyone read this book when they feel overwhelmed by their lives. I especially recommend it for male partners who expect their "women" to take care of the household. If you sign up at Laura Vanderkam's website, you can get her tracking tool and examine your own week. You may realize your life is not as gloomy as you think.


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Angry Birds

(by whizbang) Aug 20 2015

This week a wonderful article about hummingbirds appears on Slate.  For those of you unable to concentrate long enough to read this excellent piece, I will summarize:

Aztec origin myths aside, hummingbirds really are badasses. And there’s a biological reason why: Their lives depend on it.

The information in the piece only confirmed my patio observations. Last Sunday, I noticed that my feeder was empty aside from some dead ants. I noticed because a hummingbird hovered at it, then swooped by me. I know he wanted to tell me to get off my ass and get nectar out there.

So I did.

We then had at least 5 birds trying to make our feeder their territory. There may be more; they do not stay still to make counting (or photographing) easy, and several of them are the same type of bird.

King of the Feeder

King of the Feeder

I have identified the dominant bird of the past 4 days, shown to the right.

He is not the largest bird in the group, but he has successfully defended his quart of nectar. He spends much time perched on the feeder, sipping leisurely. If another bird approaches the spouts, he chases them off vigorously. At other times, he sits in a rosebush (just out of the photo frame to the left) and then ambushes the intruder.

Sneaky bird!

Despite his success thus far, he is not my favorite hummer in the yard, That title goes to the clever bird shown in the next photo.

Clever Bird!

Clever Bird!

Clever bird (to the left of the support pole) waits until King of the Feeder chases off an interloper. He then swoops in and feeds while the King is occupied. He gets chased off eventually, but only after a meal.

Of course, there are a couple of hummers that look like this guy, so they could be taking turns.

By yesterday, the King seemed to be tiring. He waited until intruders tried to drink, rather than attacking them as they approached the feeder. He also has done less defending from the rose bush, spending most time perched on the feeder itself.

These little guys are beautiful and fierce. Unless unicorns or dragons show up in the backyard, these little dudes will be the main show.

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