Physicians (Including Female Physicians) Are People Too

I am posting a compelling article written by Nina Shapiro which calls attention to an article which went viral, then was retracted due to uproar and outrage.
The original post can be found here.

Viral #MedBikini Response To Controversial Manuscript Leads Editor To Retract Article

Remember that time you saw your teacher at the grocery store? Maybe you’re still recovering from the trauma. Even though nine-year-old you knew that your teacher was, well, human, the idea that he or she engaged in human behaviors similar to those of your own family was a tough pill to swallow. Spotting a teacher on vacation? Perish the thought. What about your doctor? Your surgeon? They don’t actually eat food, do errands, or (gasp) go to the beach like the rest of us, do they? Well if they do, just hope you don’t have to witness it, right? With social media, oftentimes a click of a button will save you a trip out in public to peek at the private lives of those who care for you or your children. One group based in Boston sought to take their own peek into the lives of young surgeons via fabricated social media accounts. And they wrote about it in a highly respected academic journal.

In the August 2020 issue of the Journal of Vascular Surgery, a manuscript entitled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons,” was retracted by the journal’s editorial board yesterday. The article sought to identify what the authors consider to be “inappropriate” and “unprofessional” behavior on various social media platforms by young vascular surgeons, in efforts to recognize and, in turn, discourage, any such behavior which could have a negative impact on patient respect for physicians. While some of the issues addressed are clearly critical for patient care, including patient privacy violations, slander of colleagues, and illegal drug use, many of the other issues addressed can be construed as privacy violations into the lives of young physicians. Particularly female physicians. The investigators focused on recent vascular surgery residency and fellowship graduates, putting the average age of the study subjects (who did not give permission to be studied) at around 30-35 years old. They created “neutral” (translation: fake) Facebook, Instagram, and Twitter accounts to search the social media feeds of young surgeons.

  • The three fake accounts to search for unprofessional behavior were created by male students and fellows, ages 28-37 years old. Included in what they considered to be unprofessional behavior were photographs of “provocative” Halloween costumes and poses in bikinis. In addition, any reference to politically or socially-charged issues such as abortion and gun control were included as unprofessional behavior. The real social media world got word of this publication, and responded loud and clear. The notion that the focus was targeting young female surgeons on how they dress during their non-work time was met with disgust and uproar. The hashtag #MedBikini went viral on Twitter and Instagram, bringing countless women (and men) to proudly post pictures of themselves in bikinis or other casual attire, along with the #MedBikini hashtag, in mutual support of so-called “unprofessional” behavior outside of the operating room.

While the authors did address issues of patient privacy and uncollegial behavior, the focus on female surgeons wearing bikinis, especially tracked by male students and fellows under fake social media accounts, raised the “creep” factor to higher and higher levels as the issue came to the public. Hearkening back to the #ILookLikeASurgeon hashtag, which began in 2016, pointing out that, yes, even bikini-clad, all-shapes-and-sizes, all-genders-regardless-of-identity can be and are surgeons, #MedBikini is a trend to humanize, not de-professionalize, women in a traditionally male profession.

Dr. Mudit Chowdhary, a Chief Resident in Radiation Oncology at Rush University, shared his concerns with the study and on social media. When asked why he felt so strongly about the manuscript, he stated, “I have issues with the definition of unprofessional behavior…it is inappropriate to label social issues as unprofessional. We are humans first before physicians. Plus, the issues they label as controversial (gun control, abortion) are healthcare issues. Physicians are taught to be community leaders in medical school and we need to speak up in order to help our communities.” When asked about whether or not physicians should be held to higher standards, even on social media, he responded, “I do believe physicians should have some higher standards. For example, disclosing HIPAA information is something nobody else has to deal with. However, much of the issue is that the medical field is highly conservative and misogynistic.”

In response to such widely disseminated disgust with this publication, one of the lead authors, Dr. Jeffrey Siracuse, issued a public apology on Twitter:

And soon after, the editors of the journal issued a public statement with plans to retract the article from the journal. In their statement, they reveal that there were errors in the review process, including the issue of conscious and unconscious bias on the part of the investigators, as well as failure to obtain permission from national program directors to use the database in searching private and public social media accounts of recent graduates of training programs. Their retraction statement concluded as follows:

“Finally, we offer an apology to every person who has communicated the sadness, anger, and disappointment caused by this article. We have received an outpouring of constructive commentary on this matter, and we intend to take each point seriously and take resolute steps to improve our review process and increase diversity of our editorial boards.” (Peter Gloviczki, MD and Peter F. Lawrence, MD, Editors, Journal of Vascular Surgery).

There was some favorable response to this statement and retraction, yet many continue to feel that an assessment of professionalism was carried out in an extremely unprofessional manner, underscoring the irony of such an endeavor. Not to mention the lack of diversity in the editorial board, comprised of two male surgeons who happen to share the same first name.

While the issue of professionalism on the part of physicians should remain paramount, and does, indeed, require further exploration, monitoring, and careful attention, especially when it comes to patient privacy, social issues outside of the medical sphere should, perhaps, remain just social. But if you do see your surgeon out at the grocery store, or even at the beach, all that should matter right now is that they (and you) are wearing a mask.

The journal’s editor, Dr. Peter Gloviczki, commented that the paper had gone through the journal’s standard editorial review process, with three reviewers accepting the manuscript after major revisions. While the board is racially diverse, Dr. Gloviczki acknowledges that it lacks gender diversity. Soon after the concerns for the paper were made public, the editorial board “immediately reviewed the data collection, methodology, gender bias, results, and conclusions. It was obvious within our board that we found issues, including the fact that the list of doctors obtained from the Association of Program Directors in Vascular Surgery is designed for internal society use, not for clinical data collection.” In addition, Dr. Gloviczki noted the journal’s failure “to identify definitions of unprofessional behavior and we missed the issue of subjectivity and bias in the review process.” He emphatically apologized for the errors, stating “We learned from this. We will be changing our review process, initiating a series of changes, including expanding the editorial board to include more women.”

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Take Care Of Your Teeth!

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Have you ever spoken with someone who had such bad breath that you were tempted to turn away or shield your nose from the olfactory onslaught? If a person has such bad breath that it is very noticeable to others, his or her oral health is very poor, with excessive levels of oral bacteria. When oral bacteria levels are left unchecked, the most obvious conditions which develop are gum disease and tooth decay.

Your mouth is a veritable breeding ground for bacteria, and though most of the microbes which take up residence in your mouth are harmless, some species can also enter your lungs and digestive tract and wreak havoc on them. In addition, bacteria which enter the bloodstream from inflamed gums can travel to arteries in the heart, causing them to harden, which then causes plaque to develop on the arterial walls and impede blood flow. In plain terms, bacteria from your mouth can increase your risk of stroke or heart attack. Another vital organ in which oral bacteria can accumulate is the brain, increasing the risk of development of Alzheimer’s dementia.

So how do you most effectively control the amount of bacteria in your mouth and protect yourself against development of major diseases? The most obvious advice is to brush and floss daily, but there are also a number of other guidelines which you should follow for the healthiest teeth and gums.

FOR OPTIMAL ORAL HEALTH, DO THE FOLLOWING:
* brush teeth at least twice daily
* floss daily
* brush your tongue daily
* don’t brush too vigorously
* go for professional dental cleaning every six months
* reduce sugar intake
* get cavities filled as soon as you discover them

I know that many people get very lazy about flossing in particular, complaining that it is tedious and not worth the time. Admittedly, I used to be one of those people until about 15 years ago, when I made a concerted effort to floss daily, and I can tell you that it has made a difference. How do I know? Because when I go for my regular dental exam and cleaning every six months (and I go like clockwork), the dentist or hygienist doesn’t have much to scrape off my teeth. The trick with flossing is to curve the floss and run it along the tooth to remove any stubborn plaque and food items which may be hugging the curves and the spaces between each tooth. Once you get the hang of it, it’s a snap to do.

I also prefer an electric toothbrush with soft bristles. For those of you who use a heavy hand when you brush your teeth, bear in mind that you are wearing down your enamel when you brush vigorously. Allow the oscillation of the brush bristles to do the work. It’s also better for your hand and wrist.

Treating Low Testosterone In Women With DHEA

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Many women who have low serum levels of testosterone (normal total levels range between 15–70 nanograms per deciliter) are often wrongly convinced by their doctors, loved ones or coworkers that they are suffering from depression or stress. Low testosterone in women commonly causes fatigue, low libido and sleep disturbances, symptoms which are also found in mood disorders. The fact of the matter is, like men, women become deficient in testosterone as they age, and may manifest a whole host of symptoms.

Here are some common symptoms of low testosterone which women may experience:

muscle loss
muscle weakness
weight gain
increase in fat stores
reduced libido
decreased sexual satisfaction
vaginal dryness
low fertility
irregular periods
dry skin
thinning hair
bone loss
development of cardiovascular disease

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While some women will agree to boost their testosterone levels by using testosterone supplements (either injected or in topical form), there are numerous side effects which may emerge from such therapy. These side effects, some of which are irreversible, include hair loss (male-pattern baldness), weight gain, insulin resistance, acne, excess facial hair, hirsutism, deepening of voice, aggression, enlarged clitoris, and smaller breast size. If a woman is concerned about these side effects, she can turn to DHEA, regular exercise, and certain foods to increase testosterone levels.

A significant increase in serum testosterone levels has been consistently demonstrated during the hours following exercise, so a regular exercise regimen will naturally and safely increase testosterone levels in women. There are also numerous foods which boost testosterone levels in the body. They are:
Bananas
Pomegranate
Ginger
Asparagus
Onions
Tuna
Salmon
Oysters
Eggs
Beans
Nuts

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What if exercise and the introduction of testosterone-raising foods isn’t enough for a woman to create normal testosterone levels in the blood? A hormone which is secreted in the bloodstream by the adrenal glands known as dihydroepiandosterone, or DHEA, can be taken as an oral supplement. DHEA is converted in the body into DHEA sulfate, then androstenedione, then ultimately to testosterone and estrogens. DHEA reaches its highest levels in the body in one’s twenties, when undergoes a slow and steady decline (about 10% for each decade of life). Oh the joys of aging, right? Probably the most concerning aspect of DHEA’s decline is the potential development of major diseases such as heart disease and cancer, but another confounding aspect is the decline in the sex hormones, with a corresponding drop in muscle mass, increase in visceral fat, skin changes, and all the other symptoms associated with perimenopause and menopause.

It is widely believed that DHEA is a key hormone which can be administered as an anti-aging treatment for older individuals. One key study followed 30 male and female subjects ranging between 40-70 years of age for six months, during which time they were given 50 mg of DHEA per day for 3 months, then 3 months of placebo, in random order. It only took two weeks for patients taking DHEA to reach the serum DHEA levels of young adults, and after 3 months on DHEA therapy, the majority of subjects reported improved sleep, more energy, and less anxiety. Another study which examined women between the ages of 45-55 found that the subjects who were given 50 mg daily of DHEA had significantly higher testosterone levels than women who were in the placebo group.

If you are a woman considering boosting your blood testosterone levels with DHEA, please make sure to get a full workup and bloodwork from physician who is well-versed in hormone replacement therapy to determine whether you are indeed deficient in testosterone. I always advise starting with DHEA as opposed to testosterone, since the side effect profile of DHEA is much more tolerable than that of testosterone. I also recommend getting your DHEA supplementation compounded with pregnenolone from a well-respected compounding pharmacy for the best purity and quality. You may still experience some side effects from DHEA supplementation, especially at higher doses (in excess of 25 mg daily). These side effects include oily skin and acne, skin thickening, hair loss, stomach upset, headache, insomnia, high blood pressure, changes in menstrual cycle, facial hair in women, deepening of the voice, and fatigue.

REFERENCES
Morales AJ, Nolan JJ, Nelson JC, Yen SS. Effects of replacement dose of dehydroepiandrosterone in men and women of advancing age. J Clin Endocrinol Metab. 1994 Jun;78(6):1360-7.

Do You Need Probiotics?

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Probiotics supplements have become so ubiquitous that it can be confusing to try to determine which ones you should take. You may even be asking yourself if there is any point to taking probiotics, especially if you are already taking a handful of nutritional supplements.

So What Are Probiotics Anyway?

Our digestive tracts serve as the home for many billions of bacteria, viruses, yeasts, and fungi which are actually beneficial to us and essential for normal function. These living organisms, collectively known as the micro biome, are consumed either in foods or in a probiotic supplement, and are vital to not only gut health, but to our immunity and overall health.

Probiotics were discovered by Elie Metchnikoff, who is known as the father of probiotics. He noticed that inhabitants of rural sections of Bulgaria would live to ripe old ages despite living in extreme poverty. When he discovered that they consumed sour milk, he encountered the gut-friendly bacteria which are now known as probiotics.

Another interesting manner in which humans acquire beneficial bacteria is through the birth canal, where a newborn will be exposed to Bacteroides, Lactobacillus, Escherichia coli, and Bifidobacterium. This is the main reason why infants who are born via C-section have weaker immune systems and are more susceptible to allergies.

What exactly do probiotics do? They are believed to protect us in two ways. The first is the role that they play in our digestion. We know that our digestive tract needs a healthy balance between the good and bad gut bacteria, so what gets in the way of this? It looks like our lifestyle is both the problem and the solution. Poor food choices, emotional stress, lack of sleep, antibiotic overuse, other drugs, and environmental influences can all shift the balance in favor of the bad bacteria.

Since our immune response protects us from germs, and also since beneficial bacteria in our digestive tracts are vital to optimal immunity, it makes sense to replenish our guts with probiotics. If our digestive tracts are deficient in probiotics, we are more susceptible to infections, autoimmune disorders, and allergic reactions.

In order for a microbe to be designated as a probiotic, it must meet the following criteria:
1. It must have a documented health benefit,
2. It must be alive when taken, and
3. It must be administered at levels to offer a health benefit.

You should take at least one billion colony forming units (CFU’s) each day.

If you would like to supplement your diet with foods which contain probiotic bacteria, you can incorporate the following foods into your regimen:
Sauerkraut
Pickles
Kimchi
Kombucha
Yogurt
Goat cheese
Miso soup

What In The World Are Prebiotics, And Why Do You Need Them In Your Life?

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Prebiotics are quite different from probiotics, but they work in tandem with probiotics to have a synergistic effect. For this reason, prebiotics and probiotics are known as synbiotics.

While probiotics are live microbes, prebiotics are a type of insoluble fiber which probiotic organisms use as food. When you take prebiotics, you supply the probiotics you ingest with nutrients they need in order to thrive. These fiber sources (inulin and oligosaccharides) pass through the human stomach and small intestine without being broken down. When they reach the colon, they are fermented, producing short-chain fatty acids which are then consumed by the beneficial microbes which have set up house there.

Prebiotics are found naturally in the following foods:
– Asparagus
– Lentils
– Garlic
– Onions
– Leeks
– Oats
– Artichokes
– Bamboo shoots
– Bananas
– Honey
– Milk
– Mustard
– Rye
– Soybean
– Barley
– Wheat
– Tomatoes
– Sugarcane juice
– Sugar beet

Since the probiotics rely on the prebiotics for food, prebiotics must be taken prior to the probiotics.

Experts are now stating that by taking prebiotics, individuals can treat constipation and irritable bowel disease, immune deficiencies, and even prevent and treat different types of cancer. Other research has proven that consuming prebiotic-containing foods increases calcium absorption and bone mineral density in adolescents as well as post-menopausal women. Other studies suggest that probiotics can promote healthy body weight and optimize energy homeostasis.

Conclusion? It’s a great idea to incorporate either prebiotic supplements or prebiotic-containing foods in your daily regimen, along with probiotics, to ensure optimal gut health, support immunity, and protect against a myriad of disease processes.

Doctor, Heal Thyself

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One thing I never thought about before I went to medical school was how much I would be exposed to various illnesses as a physician. I guess you could say it’s an occupational hazard, but it can be downright frightening when you are exposed to some of the most virulent microbes which circulate in communities and in hospital environments. You’re bound to catch something at intervals.

Most people think of hospitals as disease-riddled, and they’re pretty much correct. But there are other places which have the potential to make you too weak to whip a gnat.

One of the worst environments is the pediatric setting, in which walking Petri dishes, also known as children, traipse into the clinic and somehow fling their nasty germs onto you. Before you know it, you are struck with a horrific infection that require an army of medications before you begin to feel human again. I remember spending the majority of my time in every single pediatrics rotation I completed, whether it was as a student, intern, or resident, so ill that I spent my days feeling like I had been hit by a truck, with a pressure cooker for a noggin, fuzzy-brained and miserable from whatever pathogen those little brats had brought to me.

Another microbe-filled gathering place is urgent care, a setting in which I have worked regularly over the past couple of years. Last year, when I was working more shifts than ever, I contracted three upper respiratory infections which progressed to bronchitis, and developed acute gastroenteritis (stomach flu) twice. Thank goodness I always get a flu shot every fall, otherwise I am sure I would have been hit with influenza as well. I see patients who are so sick that they can barely stay awake during their exams, people who have no business being out in public.

I recently saw a young female patient with a 103 degree fever who looked very ill, so I tested her for strep throat and influenza A&B. The nurse on staff asked if I wanted both, to which I replied, “Absolutely. I wouldn’t be surprised if both tests lit up like Christmas trees.” And they did. She actually had both influenza A and streptococcal pharyngitis. Poor girl.

It’s my duty as a physician to care for others, and I take it very seriously. But I will admit that my attitude towards my own illnesses is similar to the attitude of the Black Knight. My attitude is that it’s “only a flesh wound”, or “just a scratch” when I am ill or injured, so when I finally break down and admit that I am ill or injured, I am definitely in a bad place physically.

I suspect this attitude is similar to that of other physicians. So keep that in mind when you see that your provider is under the weather. We are only human as well.

Take Care of Your Girlie Parts

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As a follow-up to one of my more bizarre blog posts which dropped last week, I’m posting information on a couple of skin care products for a woman’s private parts. Though I have been involved in cosmetic dermatology for over 16 years, such products are honestly a surprise to me, and I wonder how gimmicky they are. I am of the strong opinion that ladies needn’t trouble themselves with detoxifying and pH-balancing an area which does a pretty good job of balancing things out on its own. I also can’t see why anyone in their right minds would be willing to blow $20 a pop on the Blackout Mask. The design of Janna’s Intimate Mask seems much more appealing, and has a more reasonable price point (about $6.50 USD), but of course it is only available in specific countries in Europe.

One use which makes complete sense to me is after IPL or laser hair reduction treatment, or waxing, since the masks would probably do an excellent job of soothing the skin post-treatment.

Here are the products:

https://www.jannauk.co.uk/product-page/intimate-mask-ph-balancing-skin-essence

Intimate Mask + pH Balancing Skin Essence
Janna’s Intimate Mask is our first anytime wearable mask that gently cares for your intimate skin. Each mask comes individually packaged with our delicately formulated essence made from natural, organic and skin loving ingredients to give you that fresh all day feeling.

Blackout (Activated Charcoal Vulva Mask)

BLACKOUT (ACTIVATED CHARCOAL VULVA MASK)
$28.00 SGD
The world’s first vulva mask. Blackout’s 4-step process soothes, detoxifies, brightens and moisturises the vulva with the help of infrared activated charcoal to boost lymphatic drainage to rejuvenate the skin.

Made with organic ingredients without sulphates, parabens or petrochemicals. Gynaecologically and dermatologically tested.

Now ordinarily I would be willing to serve as a guinea pig for any skincare products, but I’m not sure how I feel about sacrificing my goodie bits for the sake of dermatological scientific query. I’m very curious to know what the gals across the ocean think of such products?

Doctors Are Detectives

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There is tremendous responsibility in being a physician, and I take it very seriously. Any time I walk into a medical facility and see patients, I know that the patients and staff are all counting on me to assess patients fully, make proper diagnoses, and provide appropriate treatments. Basically, I know that I MUST make the right decisions at all times and be at the top of my game. Talk about pressure! Nevertheless, the thrill of solving a problem is so rewarding that it quickly eradicates any feelings of anxiety.

I just read Atul Gawande’s excellent book, Being Mortal, and I love this passage in which he very aptly describes the satisfaction which can come from being a physician:

“You become a doctor for what you imagine to be the satisfaction of the work, and that turns out to be the satisfaction of competence. It is a deep satisfaction very much like the one that a carpenter experiences in restoring a fragile antique chest or that a science teacher experiences in bringing a fifth grader to that sudden, mind-shifting recognition of what atoms are. It comes partly from being helpful to others. But it also comes from being technically skilled and able to solve difficult, intricate problems. Your competence gives you a secure sense of identity. For a clinician, therefore, nothing is more threatening to who you think you are than a patient with problem you cannot solve.”

The truth is that pretty much every physician has come across a case which he or she could not solve, one which necessitated a discussion with a specialist, or a lengthy literature review to aid in diagnosing the zebra who walked into the office that day. Physicians are human, fallible, and though they usually have the answers to the puzzles which are constantly presented to them, they may find themselves stumped every now and then, and that is a dreadful feeling.

It is an honor to serve humankind as a problem-solver, and I will always strive to keep my clinical acumen as sharp as possible in order to provide the best medical care.

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