This post comments on the idea that blog posts should be short because readers have short attention spans. It also leads readers to a long essay about home birth which breaks all of the usual blogging rules.
Read Moreadolescent misogyny
I felt very done with posting about the recent shootings, until, another one happened and until I saw this article:
Your Princess Is in Another Castle: Misogyny, Entitlement, and Nerds
I thought I had a grasp of two of the most important factors in play: guns and bullying. This article let me in on a whole other aspect of the situation of which I was unaware. It is a shocking but well written and heartfelt article. I am passing it on because I think these ideas need more exposure.
It discusses a virulent strain of geek culture wherein young adolescent men alternatively idolize and revile the attractive and popular women who don't date them. The narrative broadens to describe " rape culture " as it has been portrayed in the popular media and online. It is an eye opener. So I pass it on to you, with one caveat: Do not extrapolate and apply these observations to everyone in this social group. Nerd and geek culture is evolving and more and more it includes women.
And speaking of rape culture, can someone explain to me how so many people can tolerate watching Game of Thrones ?
Follow up on guns and culture
Here's just a brief post to thank all those who gave thoughtful consideration to my post about guns and culture. I really appreciate all the views, likes and shares. After all was said and done, the page views exceeded 6.1 K. Talk about resonance.
Here's what I appreciate even more: that so many people on both sides of the issue had genuine insights, free of stereotypes, hyperbole or inflammatory language.
I'd like to refocus attention on the bullying aspect of the Santa Barbara tragedy. A couple of posts ago, I posted the following about efforts to deal with bullying :
Popular California kids in 1979
"What work that has been done thus far, seems to have, perhaps of necessity, focused on the victim, and the bully. However I feel, and this is not evidence based, we must turn now to the people who hold power: Teachers and popular children. "
Since then, I have been doing a little bit of research to see if there actually are evidence based approaches to bullying. It turns out there are. These approaches are more broadly based, and deal with far more than the victim and the bully, who incidentally, not uncommonly, trade places. You can see the particulars here in this list of resources:
http://antibullyingresources.pbworks.com/w/page/34981845/Best%20Practices%20in%20Bullying%20Prevention%20and%20Intervention
The essence of the approach is this: the interventions must involve everyone in the setting, be it school, the workplace, or wherever. Bullying, bystanding (my word ) and being a victim are all parts of a dysfunctional whole that has to be undone bit by bit from the inside out.
Our evolution as humans took place in a natural environment of hostility and scarcity. Our inborn traits of dominance and aggression were necessary for survival. However now that we are beginning an age of what I hope is abundance and cooperation, we are having to learn to transform and transcend our hard wiring as well as our primitive culture. As I read through the sociological and behavioral science literature of bullying, it became clear that we are only just beginning to understand.
A letter to my California friends about Montana, guns and culture
Last night we attended a lovely reception for my aging in-laws in honor of their long patronage of Western art. We viewed everything from Charlie Russell paintings to traditional doeskin dresses. How fitting then was it that the reception was held at a shooting club. Entertainment included the shooting of trap. I was captured in photo while shooting, and Echo my daughter declared the image Facebook worthy. But a concern rose in my mind, so I wrote this letter.
Dear California friends,
We Montanans stand with you in your grief and outrage at the recent violence in Santa Barbara. We share your concerns about gun safety. As my daughter posts these photos of me shooting. I am concerned you will consider it insensitive in light of the recent tragedy. So I offer the following thoughts.
I think these type of photos are apt to translate very poorly on the current national stage. It is not difficult to confuse issues of guns in California, guns in the tragedy versus guns in Montana at a shooting club. I want you to know I have given it some thought, on whether I should, out of sensitivity, ask Echo not to post pictures from the party. I decided rather that I would let happen what would naturally happen, especially since her posting is out of a sense of pride and celebration.
Something up here in Montana feels naturally resistant to violence of that particular nature. Sure we have our rare crazies like anywhere else. Up here though they more often than not leave society and hole up in the mountains. Observing more generally, one finds there is a modicum of knowledge and more importantly a code of honor associated with firearms that has not exported to more urban places with weapons. Perhaps this is related to how we educate our kids. Hunter's Safety is taken here by the majority of kids when they turn eleven. It is several nights a week for several weeks, conducted by Fish Wildlife and Parks together with the schools. It is a really big time investment for the parents and kids and a colorful community rite of passage. There is a small but important book given to every person during the program. It is called " Beyond Fair Chase" and it is about the ethics and traditions of hunting. Consider having a look.
Maybe the secret sauce is the social cohesion all this engenders. Here, guns signify responsibility and together with hunting, and a bit of independence. At the same time, hunting means family time, gatherings of friends and magnificent meals.
Hunting culture teaches several other things worth mentioning. It puts one deep into nature, illuminating both its grandeur and intimacy. It requires teamwork, planning, patience and perseverance. It makes graphic the power and potential violence of weapons and hints at the horror of war and crime. Lastly, It brings ordinary people close to loss of life. I have heard more than one cold wet, weapon burdened hunter come in and wonder how war or massacres could have ever taken place. In this setting, hunting seems to sensitize us to these realities, rather than desensitize. People, nature, life and death are brought into close juxtaposition and we come to understand them better.
I feel Montana voices are especially important in the discussion on weapons related violence. It is my hope that lessons from hunting culture can contribute something toward making cities safer.
Sincerely,
Gina
California girl transplanted to Montana
Ending Bullying; Changing the way we make change
As I write, many of my friends in California are reeling from the tragedy in Santa Barbara. I write to highlight that once again mental illness and bullying are at the bottom of it.
Clearly we have not done enough to address these two issues. I don't have the answers. I do know a systematic evidence based approach is necessary to address the problems of both mental health and bullying. From my perspective as a physician, the mental health community already has a good grasp of the problem. I'm not so sure about the teaching community. More importantly, and sadly, whatever insights and interventions these communities possess, their implementation of them is sorely lacking.
I studied diffusion of innovation as an undergrad at Stanford. A new belief, outlook or a behavior is actually an innovation of sorts. Sometimes we call them memes, a repeating, or contagious entity. I believe we ought to leverage our understanding of memes, innovation and behavior change to tackle the problem of bullying. We ought to bring in the experts in this field: ADVERTISERS. To really make inroads into the darkest corridors of middle school, or the supervisor's private meeting at work, knowledge of bullying and it's solutions must permeate our culture.
What work that has been done thus far, seems to have, perhaps of necessity, focused on the victim, and the bully. However I feel, and this is not evidence based, we must turn now to the people who hold power: Teachers and popular children. In the literature of innovation, it has been found that there are certain index figures, also called champions, influencers, or early adopters. It is these people that need to be identified and leveraged for this most important cause.
Some helpful references :
stopbullying.gov
http://www.apa.org/topics/bullying/
http://www.thebullyproject.com
http://www.bullyingstatistics.org
http://www.nlm.nih.gov/medlineplus/bullying.html
Big Soda versus Milk
I love a cold carbonated drink. Who doesn't ? But I am on a mission to get my patients off of soda. Why pick on one particular junk food and not them all ? Soda pop is a special concern to me since I care for girls and women.
I have tried to educate my patients, young and old, about carbohydrate metabolism. Carbohydrates are the starches and sugars in our diet. We need them for energy, but we can only absorb them at a certain rate. The modern food industry has altered natural food materials in such as ways to make them taste good and not spoil. In short, they have processed the food, and that basically means the food is already partially broken down and relieved of its perishable nutrients. It is also filled with strategic additives to recolor, reflavor, or stabilize. When we eat processed carbohydrate, it jets right into our bloodstream since there is little breakdown left to do. The gratification is quick and the effect is almost addictive. Of course this is by design on the part of the food industry.
Soda pop is the epitome of this phenomenon. I think of it as a sugar water IV. Even a young non diabetic person will raise their blood sugar beyond what it should be. What does the body do with excess sugar that it can't burn ? It stores it as fat.
So many of us work hard to keep the waistline trim, and it turns out that is worthy goal. Truncal or waistline obesity is associated with cardiovascular disease. I have seen patients who drink large amounts of soda reduce their waistline and weight by just quitting that one thing.
There's a special concern about girls, women and soda pop, and that is that it displaces milk as a common go-to beverage. It is consummately uncool to drink milk. I want that to change. You see, women are living longer than ever and in their older years, bone thinning is becoming a bigger and bigger problem. We women only have until the mid thirties to build are bone density. After that it's all downhill. It's just a question of how fast downhill, and from what height.
So it is very important for girls and women to drink milk to build bone. Milk is rich in protein, Calcium, vitamin D and water. They need not be concerned about taking in too much fat, since skim or nonfat options are available everywhere. Furthermore, those with lactose intolerance can now find lactose free varieties on every street corner.
It is worth mentioning that claims that soy, coconut, rice, almond, or hemp milk are superior are unfounded. None of them contain complete protein. They are essentially a complex carbohydrate and their role in a diet should factor that in. If as a lactose intolerant person I order a latte where there is no lactose free milk, I am happy to get one of these substitutes as the mood suits, but they are not a dietary substitute for milk from mammals such as cows or goats.
So how am I going to get my fix for an ice cold carbonated drink ? Easy. I am going to buy one the newer elegant low sugar natural fruit based sodas. Or, even better, I am going to go home and mix plain club soda with crushed ice, a small splash of real fruit juice and a twist of lime.
For more information about Big Soda, go to The Center for Science in the Public Interest.
Pomp and Circumstance
in family
This weekend I shared the fantastic surreal experience of college graduation with my family. For weeks my son in law, who was receiving a Masters degree, had said he was not going to walk. As the date grew near, he changed his mind just in time to order his robe, hood and cap.
Brian is a practical sort, and had little use for the multicolored hood and strange flat hat. However he listened patiently as I explained that it was a communal rite of passage that would never happen again. When he rolled his eyes, I cut to the chase, and enlightened him that it was mostly for his parents. I helped him adjust his hood correctly and explained that the outer colors represented his university and the inner colors represented his college, in this case, agriculture. He would be joining the ranks of centuries of scholars donning the colored robes of academia. Echo, his wife, my daughter, came in and out in a flurry, getting ready. When she returned, I mentioned something to which I thought she could relate.
Our family has been to England, specifically Oxford and Cambridge. There we visited the ivy clad walls of King's College and punted on the river Cam, floating under the bridge of sighs. We were told the bridge connected dormitories to the great exam hall, thus explaining its name. In the main exam hall, we all felt as though we had been there before. It was darkly paneled room, with grand weathered wooden table running it's length. High on the walls were portraits of ancient robed scholars. Robed ! Of course. In those days, all students wore robes as they attended school. Their robes were plain, and as they advanced, graduated and attained various honors, their regalia increased, with tassels hoods and caps. Our tour guide explained that the room had served as the model for the great hall in Hogwarts. No wonder we felt at home.
Back in bozeman I decided to fall short of telling Brian that he was becoming a wizard. Even a good mother in law is indulged only so much. True enough, his robes heartened back to the academic robes of old England, in a world where education may as well have been magic, the purview of an elite few, and requisite for power.
I raised my kids in a melange of academics, science, fiction and fantasy. Thus I knew Echo would appreciate my reference back to the academic vestments of old. I knew too that in Marvel's fictional world of Asgard, Odin was right, saying that which we called magic was really just more advanced science.
And so the day saw Brian invested with his Masters degree. We listened to several addresses, each of which was surprisingly illuminating, intense or touching in turn. The graduates were given their diplomas, charged with their rights and responsibilities and we adjourned. But sure enough, the Professors had done their magic and a a spell had been cast. Brian would go home with a good job waiting for him. He would also leave with and enlarged affection for science and the near magical ability to conduct research.
After the ceremonies, we returned to have an open house and pack. And pack and pack. Though we were returning to the mundane, here was no denying that a transition had been crossed. We could all feel the surreal quality of the transition from one phase of life to another. Time and memory were in sharp focus and set apart. We were all transformed a bit, in this magical circumstance.
The Unexpected Benefit of Being the Worst Yogi in the Room | Greatist
This is a fantastic funny article from Greatist about beginning down the path of fitness.
" The Surprising Benefit About Being Bad at Yoga "
I am always encouraging my patients who do not exercise to explore it. I tell them that what they do does not matter so much as just doing it. I ask them to start slowly, and to quit before they are overly tired. I have explained that their muscles, ligaments and joints need weeks to adjust to the new routine.
Some people like to go three or four days a week for a hour or more. This can be appropriate for seasoned athletes, but for those still establishing a solid routine, I prefer 6 days a week of at least two or three different workouts, for only about 20-30 minutes. With this high of a weekly frequency, a habit can be established. With such a low duration, it won't be too hard. Nor will it be allowed to interfere with the daily schedule. In short, it should be sustainable.
Here's a funny thing I hear at the office. " I can't go to the gym until I get in better shape. " This leads me back to the point of this article. When I was taught yoga back in my groovy Southern California high school , we were told to begin by observing and accepting our present state. In doing the poses, we were cautioned to listen to our body, and lean into them only insofar as it felt healthy. This was part of what is now called " mindfulness " or being " present". One of my best high school friends said it best : " Be here now."
Yoga has never been about others. It is a gentle practice wherein we gain the physical skills of strength, stamina, relaxation and flexibility, and the mental skills of self calming and focus. Any exercise or sport can achieve similar goals but it must be a properly crafted regimen with a warm up, a cool down and sensible sequence. Those who are just beginning in fitness do best with some form of guidance. Ideally this is with a class and a teacher, but it can also take place with a DVD at home . That way the truly self conscious can get a taste of the benefits of yoga and similar workouts.
I blogged about this article because I think it did a great job of showing the transformation from disliking exercise to loving it, something I wish all my patients could experience.
Health Law’s Pay Policy Is Skewed, Panel Finds - NYTimes.com
Doctors have always been skeptical about the real meaning of the health policy term " quality". On the face of it, quality medicine seems like an incontrovertibly good thing. It is also called "performance". It means the absence of problems in one's patients. It also means having patients with shorter stays, fewer diagnostic tests and fewer readmissions. The assumption behind all this is that quality medical care leads to less ill patients. Fair enough, at least in a few circumstances where doctors can control the majority of the variables. The strange thing is that government and insurance companies then infer that the converse is true: that ill patients means doctors are performing less well, and that their medical care has lesser " quality". They then reason they can justify paying caregivers less for less "quality" and poorer "performance" . This is the real meaning of " Pay for Performance" or P4P.
Government and insurance companies are the third party payers in this scheme. The patient is the first party, the doctor the second, and the payor is the third party. These payors want to pay out as little as possible, not only to the doctors, but altogether on behalf of the patients. Patients with shorter stays, fewer diagnostic tests and fewer readmissions are CHEAPER patients. So if a doctor wants to keep her " quality " and her " performance " up, she had better shy well away from older, sick, or high risk patients. Not only would she have more work, more heartache, more complications, but less pay too, and a designation of being a poorly performing low quality doctor. Talk about adding insult to injury.
Don't worry. Most of us signed up to take care of people who need us. Most of us actually prefer practicing at the higher end of our skills, which means taking challenging cases. Additionally, most of us don't mind looking at our own statistics or " performance". We prefer to. We want to know our own rates of infection, primary C section, or length of stay. Most of us are not going to change how we take care of patients because of the bean counters. We know our own data is best used to help us make ourselves better doctors. It should not be used by third party payors to justify pressuring us to take care of patients more cheaply. I was glad to see this New York Times article on my home page. It's just nice to know that this discussion about " quality "and " performance " is out in the open.