Time for More Physicians to Embrace Advocacy

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Why eat organic?

I wasn’t always a huge supporter of eating organic.  I was a poor college student… a poor medical student… and a poor resident.  In fact, I didn’t start thinking about my health seriously until my husband and I were planning to get pregnant.  Maybe this was a little late in the game at 37 years old… but better late than never, right?

In college, I lived off of lean cuisine microwaveable meals with plastic and drinking 3 diet dr. peppers a day.  In medical school, I survived off a protein bar, sandwich, and microwaveable dinners as well.  Did I mention that I experimented with smoking to help me study?  Ick, what horrible habits!  In residency, I continued with protein bars, microwaveable meals, and hospital food that was free for residents around 9p.  Not to forget, that I made sure I went to a bunch of residency interview dinners to meet potential incoming residents.  Fast forward to getting ready for my wedding day, I went 3 months on a paleo diet and felt incredible and saw real changes in my body without feeling deprived or hungry.  We went organic during my first pregnancy.  We’ve placed more importance on sustaining our baby and helping her maximize her growth and learning with a more nutritious diet.  During my second pregnancy, I again ate organic.  But, I was diagnosed with gestational diabetes and moved to a more Whole30 diet — eliminating processed foods as well as sweets.  I was able to really control my blood sugars with diet alone, and I feel better without all the processed food and sweets in my system.

Why do I think about this now?  More and more, I feel the impact of a well-balanced diet on my body.  My AGING body.  Perhaps in our youth, we can fake it and make it by eating crap food and maintaining an unhealthy lifestyle.  But as I’m aging, I feel the effects more and definitely sooner.  Additionally, I care more now about what I put into my body and in my family’s.  I would love to teach my kids the importance of healthy eating and what good food tastes like.  So, enter my quest to eat organic as well as grass-fed, hormone-free meats as well as going more plant-based.


Resources:

HelpGuide – Organic Foods: What You Need to Know

HelpGuide – Healthy Food for Kids

Mayo Foundation for Medical Education and Research – Organic vs. Non-Organic PDF

MindBodyGreen – A Doctor’s Top 4 Reasons to Eat Organic

Dr. Axe – Dirty Dozen

EWG – EWG’s 2018 Shopper’s Guide to Pesticides in Produce

Dirty-Dozen-Clean-Fifteen

Time – 4 Science-Backed Health Benefits of Eating Organic

The Organic Center – Bringing you the science behind organic

Food Safety Magazine – 2018 Dirty Dozen and Clean Fifteen Lists Rank Produce Items by Pesticide Level

Association between organic food consumption and metabolic syndrome: cross-sectional results from the NutriNet-Santé study. Eur J Nutr. 2018 Oct;57(7):2477-2488.

Human health implications of organic food and organic agriculture: a comprehensive review.  Environ Health. 2017; 16: 111. 

Organic Food in the Diet: Exposure and Health Implications. Annu Rev Public Health. 2017 Mar 20;38:295-313.

Are organic foods safer or healthier than conventional alternatives?: a systematic review.  Ann Intern Med. 2012 Sep 4;157(5):348-66.

Nutrition-related health effects of organic foods: a systematic review. Am J Clin Nutr. 2010 Jul;92(1):203-10.

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Clean Label Project: Methodology

Center for Ecogenetics and Environmental Health: Health Risks of Pesticides in Food

U.S. Right To Know: Monsanto Papers

U.S. Right To Know: Pesticides

Time: Why Organic is the Right Choice for Parents

NBC News: What a nutritionist wants you to know about pesticides and produce

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U of Washington Center for Ecogenetics & Environmental Health

Key Points

  • Eat organic and free-range/cage-free/grass-fed/hormone-free when possible
  • Pesticides are toxic and can lead to health problems later in life
  • Choose organic alternatives to the Dirty Dozen
  • Babies, young children, pregnant women, and breastfeeding women are more susceptible to pesticides and toxins in food.
  • Research the labels and get the facts
  • Consider these Netflix documentaries on Health and Nutrition

The Independence debate in Anesthesia

The independence debate in anesthesia. #anesthesiologist #physician @nmsahq @asahq Physician-led anesthesia care team provides patient safety, which is the #1 priority in patient care. #va #patientsafety #healthcare

The physician vs. crna debate has reared its ugly head…. yet again.  There have been multiple bills presented to suggest crna independence WITHOUT physician anesthesiologist oversight.  In 2017, proposals were made to the Veteran’s Affairs to replace physicians with crnas.  Here’s what they found when they looked at the VA databases to conclude that nurses will continue with physician oversight in anesthesia:

Current laws in 45 states and the District of Columbia all require physician involvement for anesthesia care and the VA in 2017 decided to maintain its physician-led, team-based model of care. The VA’s Quality Enhancement Research Initiative (QUERI) could not discern “whether more complex surgeries can be safely managed by CRNAs, particularly in small or isolated VA hospitals where preoperative and postoperative health system factors may be less than optimal.”

Here’s my evidence and reasons why I believe the care of the patient is best when it is physician-led.  After all, would you want a nurse or assistant doing your actual surgery?  The ultimate goal is patient safety.

Physician anesthesiologists have up to 14 years of post-graduate medical education and residency training, which includes 12,000-16,000 hours of clinical training, nearly seven times more training than nurse anesthetists.

From 2010:

From 2011:

From 2017:

 

Yet, here’s another debate that shows there’s no difference in an anesthesia care team setting with an anesthesia assistant and a crna:

Bottom line in my opinion:

  • Physicians endure years of grueling medical education that starts with the why, how, and treatment of disease. This is followed with years of residency training in anesthesia. There’s also further training in the form of a fellowship for specialized fields.
  • Getting into medical school is an extremely competitive process. You take the top 1% of college graduates and high MCAT scores to get into medical school.  The board certification for becoming certified in anesthesiology is quite complex and difficult in both the written and oral board exams.
  • I will continue to be FOR team-based physician-led anesthesia care.

Arden’s 1st birthday


Written Jan 2, 2019

I can’t believe Arden is almost a year old! Where did the year go?! I’ve got to start getting ideas for her bday as well as invites, food, party favors, location, etc.
Brainstorming:

The number ‘1’ photo collage of Arden: Ribbet, ShapeCollage, Shutterfly

Electronic invites: Paperless Post

Catering: Yelp Taco catering, Yelp food truck catering

Location: Carmel Valley parks

Carmel Valley Community Park and Recreation Center
3777 Townsgate Drive
San Diego, CA 92130
(858) 552-1616

** Insurance for caterers/vendors/food trucks needed. No glass containers. Alcohol is permitted. If >50 people, then $175 for day use. Tables 1st come, 1st serve.
Things to get:

  • Inflatable swimming pool: Amazon
  • Balls to fill pool: Amazon
  • Bubbles: Amazon
  • Gluten-free Cupcakes
  • sheet cake – Costco?
  • one small cake for Arden
  • decor for Arden high chair: Amazon
  • Plates, silverware, napkins
  • alcohol
  • 529 gifting: https://gift.my529.org/1RU6HD
  • Party favors: bubbles, pinwheels, Amazon
  • Photographer?

Paid Maternity Leave

I had just written a response to a partner’s email regarding outpatient coverage and the focus of work-life balance.  I think it’s a great initiative that she is tackling while brainstorming what could help the group with flexibility as well as some normalcy while raising a family.
This made me think of changes to antiquated practices we currently have in our work environment… primarily, paid maternity leave as well as paid sick leave.  Many of my male colleagues can continue to work and can take as little or much leave as they would like for family bonding or vacation time to spend with their newborns.  This is their option.  Unfortunately, the women physicians in our group are not afforded that same luxury.  There is a 6 week medical leave of absence with a vaginal delivery or an 8 week leave of absence with a C/S as proposed by the OBs.  During this time, we are not paid.  State disability is a joke bc it’s not even enough to cover a mortgage payment.  Look at other large companies, there’s often paid leave or sick leave available to the employees.  Therefore, women who choose to have kids while working as a physician in our group are penalized, especially if they are the breadwinner.
Not only that, even while off on medical leave, we are required to pay into the trust and pay ridiculously high premiums to cover the wide age gap of partners in our practice.  I would be happy to look elsewhere for my medical coverage, but I simply cannot come off our medical insurance plan.
Therefore, I propose there be a fund set aside to create a pool or trust for persons creating families (just as we do for our more distinguished and elderly physician population with our health insurance plans and exorbitant premiums) who will have families and work in our group.
Here are some examples in the news of what is and has been in the pipelines….
Here are examples of companies getting it right:
Please consider updating some or all of the policies for paid maternity leave.  I am open to your thoughts and considerations.

 

Poll on Maternity Leave

What it’s like to be a female anesthesiologist…

Montessori floor bed

As Arden is getting older and bigger, I’m wondering if she will outgrow her pack and play that has been her bassinet and crib since she was born. At school, she naps on a floor bed. The times we have tried to get her to nap at home on a floor mattress, she wanders around her room. That was prior to her really crawling around. Now almost 11 months old, she is so fast at crawling and getting around…I’m worried she’ll wander around her room and not get a good night’s rest. But, maybe the ability to explore and be comfortable in her own space is exactly what she needs…

One family’s Montessori floor bed experience from 2013

How we Montessori – Transitioning to a floor bed

ClockWorkRise – Floor bed transition

Kavanaugh report: realities of a montessori floor bed

CanDoKiddo: Montessori floor bed sleep problems

The Full Montessori: floor bed confidential

The Baby Sleep Site – How and when to transition your toddler from a crib to a bed

YouTube: Live well, Jess – Montessori floor bed experience

YouTube: Why not Montessori – Montessori floor bed and Our Experience

YouTube: Mellow Mama – Montessori floor bed