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I am posting a compelling article written by Nina Shapiro which calls attention to an article which went viral, then was retracted due to uproar and outrage.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Surgery, a manuscript entitled “Prevalence of Unprofessional Social Media Content Among Young Vascular Surgeons,” was retracted by the journal’s editorial board yesterday.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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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.

It’s Dr. Naito, NOT Dr. Stacey

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Proud to be a Doctor vector emblem design

Some of you are in the habit of referring to physicians by their first names, tacking on “doctor” before the name. In all honesty, those of you who do this are quite honestly showing disrespect in doing so, even if it isn’t your intention.

Please bear in mind that we physicians must endure four years of medical school, anywhere from 3 to 7 years of residency training, and for some physicians, additional years spent in fellowships. In addition, we must keep up with continuing medical education (my yearly requirement is at least 50 hours), maintain licensure, and recertify every few years for our board certification credentials.

So when doctors bristle at you calling them, “Doctor Bob”, “Doctor Stacey”, or “Doctor Karen”, don’t be surprised. It’s not cute, it’s far too casual, and again, it’s downright disrespectful.

I do NOT like being referred to as Dr. Stacey at all. I worked very hard to become a physician, and I deserve to be referred to properly. In addition, I refer to other physicians as Dr. (last name) at all times, unless a colleague gives me permission to refer to him or her on a first name basis.

If you have an issue pronouncing a doctor’s last name, ask the doctor for assistance in pronunciation. Sometimes, the physician may suggest that you use the first letter of the last name as an abbreviated version. For example, I could be referred to as “Doctor N”, which I am fine with. I will not respond well to “Doctor Stacey” or “Stacey” by a patient.

In case you were wondering, Naito is pronounced like “night”, with a long “o” at the end.

Are there any medical doctors out there who would like to chime in on this one?

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.

Understanding The Costs Of Diabetes Treatment And Planning For The Future

Original post can be found at:
https://www.thesimpledollar.com/understanding-the-costs-of-diabetes-treatment-and-planning-for-the-future/


by DeVonne Goode
Updated on 06.05.18

Diabetes is a prevalent disease. However, it can still take many by surprise, and leave them struggling to pay medical bills.
With the complexities of the condition and the wide range of costs involved with treatment, having a financing plan is necessary. Health insurance is obviously one of the primary methods of assistance. But not everyone has the adequate coverage to cover
the costs – let alone the out-of-pocket cash to put on the counter every time out.

Opening a savings account, particularly one with high interest, could be a worthwhile investment toward consistently managing the disease today and into the future.

Diabetes at a glance
Type 1 Diabetes

A condition that keeps the body from producing enough insulin. Insulin shots are used to control blood glucose levels. Most diagnosis occur among children and young adults, which is why it is also referred to as juvenile diabetes.

Type 2 Diabetes

The most common form of the condition where the body doesn’t properly use insulin to convert sugar, starches and other food into energy.

Gestational Diabetes

Occurs when women experience high blood glucose levels during pregnancy. It’s usually easily managed and goes away after pregnancy.
Prediabetes

When blood glucose levels are higher than normal, but not high enough to be diagnosed as Type 2 diabetes. A large number of Americans are living with prediabetes (1 out of 3 adults). But taking early action to manage glucose levels can prevent diabetes from forming.

People who have diabetes are at higher risk of developing the following health conditions:
Blindness
Heart disease
Stroke
Kidney failure
Blindness
Loss of lower appendages (toes, feet, or legs)

Keep in mind – these conditions occur in the case of severe complications with the disease. With consistent attention to diet and other medical treatments (like most living with type 1 or type 2 diabetes undergo), these conditions are avoidable.
Diabetes by the numbers

According to a recent report from the Centers for Disease Control and Prevention (CDC), more than 100 million U.S. adults are now living with diabetes or prediabetes. Of that, only 12% were aware that they had it. And with approximately 1.5 million new cases being diagnosed every year, the need for education and financial support is clear.

Prevalence
Infogram

Rates of diagnosis for the following ethnic groups
7.4% of non-Hispanic whites
8.0% of Asian Americans
12.1% of Hispanics
12.7% of non-Hispanic blacks
15.1% of American Indians/Alaskan Natives
Breakdown among Asian Americans:
4.3% diagnosed were Chinese
8.9% diagnosed were Filipinos
11.2% diagnosed were Asian Indians
8.5% diagnosed were identified as other Asian Americans
Breakdown among Hispanic adults:
8.5% diagnosed were Central and South Americans
9.0% diagnosed were Cubans
13.8% diagnosed were Mexican Americans
12.0% diagnosed were Puerto Ricans

Underreported deaths due to diabetes

Diabetes is one of the leading causes of death in the United States (seventh as of 2015). However, studies have found that it is also among the most underreported. According to the American Diabetes Association®, only 35% of people who died with diabetes had the disease listed on their death certificate. And of that number, only 10% had diabetes identified as the cause of death.

Underreported Deaths
Infogram

There are a number of possible reasons for the underreported rate. But a lot points to the lack of ability to pay for adequate diagnosis and proper medical treatment.

What specific costs will someone with diabetes have to address?

If you or your child are diagnosed with diabetes, or you’re told that you have prediabetes, management and prevention take center stage. While a lot involves diet and exercise, medication will inevitably have an effect on your finances as well.

According to the American Diabetes Association® (ADA), medical costs for a person with diabetes averages out to $16,750 per year (a total of $327 billion nationwide in 2017). Of that amount, $9,601 is attributed to treatment specifically for diabetes. That’s more than twice the medical cost for people without diabetes.

Of the $327 billion nationally, $237 billion was attributed to direct diabetes medical costs and $90 billion was attributed to indirect costs – absenteeism and reduced productivity at work. Understanding the different forms of diabetes treatment, as well as the direct and indirect costs, is important for wrapping your head around plans for financing.


Type
Treatments

Type 1 Diabetes
Diet
Exercise
Insulin therapy
Regular blood glucose tests/monitoring

Type 2 Diabetes
Diet
Exercise
Insulin therapy
Other medication
Gestational Diabetes
Diet
Exercise
Monitoring sugar intake
Monitoring the baby
Direct Medical Costs ($9,601/year)
Indirect Medical Costs ($90 billion nationally)
Prescription medication (30% of total cost)
Loss of productivity due to mortality ($20 billion nationally)
Hospital care (30% of total cost)
Inability to work as a result of diabetes ($40 billion nationally)
Routine doctor’s office visits (15% of total cost)
Reduced productivity while at work ($30 billion)
Other medications and supplies (25% of total cost)
Reduced productivity due to increased absences and loss of employment from diabetes ($6 billion)

Insulin

Insulin injections are one of the primary forms of medical treatment used to manage diabetes. Especially for those living with type 1 diabetes, who can’t produce insulin of their own, these types of injections are vital for survival. However, the cost for insulin has skyrocketed in recent years, leaving many in the position of having to choose between going into debt or cutting back on medication.

Average cost for insulin as of 2015: $100-$200 per month
Average cost for insulin as of 2018: $400-$500 per month

WIDELY USED INSULIN BRANDS AND INSULIN INJECTION TOOLS
Insulin
Apidra, Humulin, Lantuo, Lente, Levemin, Novolog, Novolin, NPH Insulin, Regular Iletin, Regular Insulin, Velosulin
Insulin Syringes
BD Ultrafine, Levemir®, Monoject, NovoFine®, Ulticare, UniFine, UltiGaurd
Insulin Pumps
Animas, Deltec, Medtronic

Diabetes screenings and other medications

Along with your normal doctor’s visits, diabetes screenings are an important part of the process for identifying the disease. Specifically, if you have been diagnosed, testing your blood glucose levels will become a regular part of your life. Much of the costs for medications involved should be covered by your health insurance. And there are a number of home testing devices you can invest in to help make things more convenient and cost-effective.


WIDELY USED DIABETES TESTING BRANDS AND OTHER MEDICATIONS

Blood Glucose Test Meters and Test Strips
Abbott Freestyle®, Abbott Flash, Accu-Chek Compact®, Ascensia Elite, Ascencia Breeze, Ascensia Contour, Lifescan One-Touch©, Prestige
Injectable Medications
Byetta (Exenatide) injection and Symlin (Pramlintide Acetate) injection, Victoza (lLiraglutide- rDNA origin) injection
Oral Medications
Acarbose, Avandia, Chlorpropamide, Diabinese, Glipizide, Glucophage, Glucotrol, Gylset, Meglitol, Metformin, Prandin, Precose, Repaglinide, Rosiglitazone (These drugs act in different ways to lower blood glucose levels and may be prescribed in combination with other medication.)


Diabetes health expenditures according to group

Depending on whether you or your child has type 1 or type 2 diabetes, total expenditures can vary. Those who manage their condition at home, through diet, exercise, and home testing will have different averages than those needing regular appointments with specialists. According to the American Diabetes Association®, average total healthcare expenditures for diabetes treatment differ according to gender, race, and states with the highest populations of people diagnosed.

Gender
Men: $10,060
Women: $9,110

Race
Hispanics: $8,050
Non-hispanic Blacks: $10,470
Non-hispanic Whites: $9,800
States with highest population of people with diabetes
New York: $21 billion in healthcare expenditures
Florida: $24 billion in healthcare expenditures
Texas $25 billion in healthcare expenditures
California: $39 billion in healthcare expenditures

Options for diabetes treatment financing

In a recent online survey of 500 adults with diabetes, more than half of the participants acknowledged the medical costs involved has had a negative impact on their finances. Many also admitted to going to “extreme lengths” to cover the costs. These lengths include accruing credit card debt, borrowing money from family or friends, and tapping into a savings or retirement account. Many may feel the need to take some extra financial risks because they don’t feel as supported as they’d like. Understanding your options will help you make the most informed choices.

Insurance

Government insurance, such as Medicare and Medicaid provides most of the financial assistance for diabetes care. The military also takes care of a good amount of costs for veterans. The remainder of the cost is covered by private insurance or out-of-pocket cash. According to the National Conference of State Legislatures, 46 states mandate that diabetes be covered under state insurance.

Diabetes Health Insurance Coverage
Infogram

These states require coverage for diabetes treatment as well as equipment and supplies for home use (insulin, pumps, syringes, test meters). Four states do not have that same insurance mandate, however – Ohio, Alabama, North Dakota, and Idaho. Anyone with diabetes who live in any of those four states will most likely need to deal with a private insurer or explore other methods of financing.

Coverage from private insurers usually come through employer-sponsored group plans or individual health plans. Advisors would suggest going with employer-sponsored plans, because they offer higher protections due to being subsidized. On the other hand, if you are unemployed and venturing into the individual market, it may be difficult to find affordable coverage. The reason is that diabetes is considered a “high risk” disease. Insurance companies anticipate a high amount of claims, especially from those with pre-existing conditions. So it will be reflected in the pricing.

HSA

People who have diabetes but don’t have coverage that’s comprehensible enough for their needs may utilize a health savings account (HSA). An HSA is primarily useful for people with high deductibles (at least $1,350 individually, or $2,700 for family). Also, those who are a part of low-income families or don’t live in a “mandate state” may see this as a helpful tool. One big benefit of an HSA is that you take the money with you. There’s no “use it or lose it” policy like some other savings plans. Being able to set aside pre-taxed dollars to help pay for medical expenses can go along way when trying to manage diabetes.

FSA

Another way to set aside dollars for medical expenses is through a flexible spending account (FSA). An FSA is provided through your employer with a $2,650 limit. You can also use it to cover medical expenses for your spouse and dependents. One thing to keep in mind with FSA’s is that they do have an expiration period. You’re generally required to use the funds within your plan year. But your employer may offer extensions at their choosing. The benefit is, it can be used with any type of health plan. And diabetic supplies are eligible to be paid through FSA’s.

High interest savings account

If you’re not interested in dealing with your employer for coverage or a flexible spending account, a high interest savings account could be a good option to explore. It’s just like any other savings account, only with fewer restrictions. Not only are you saving for your medical needs, but your money is also making money. High interest savings accounts are opened through online banks – which means they don’t have to worry about maintaining branches all over the country. They can offer you higher interest rates, with the benefit of accessing your money whenever you want.

Unlike an HSA, a high interest savings account isn’t tied to a high deductible health plan with a dollar limit. And unlike an FSA, there’s no expiration date on when you can use your money. It removes any additional stress so you can concentrate on managing your condition properly. And as you earn interest, you can still take advantage of a number of outreach resources available for people with diabetes.

This condition can be a tough one to get a handle on, but it’s not insurmountable. Let your understanding of diabetes, your knowledge of its treatments, and your strategy for tackling costs work in your favor.

Stacking The Deck

“So…what do you DO?”

This question is incredibly annoying to me, and I cringe every time I hear it. I resent the fact that many people are so quick to assess someone on the basis of what they “do” for a living, as if there are no other dimensions which should be taken into account.

I completely resent the demand to pick one career that defines me. To add insult to injury, when people find out that I am a medical doctor, they struggle with the stereotype of what they expect doctors to be like, in other words, very conservative in dress and demeanor, and without any flavor or personality. Well, I’ve got news for you. I will NEVER be a typical doctor. And please don’t doubt my credentials or schooling. I am NOT a nurse (not that there is anything wrong with this highly respected profession). I am a fully licensed and board certified physician.

However, I do not consider myself to be ONLY one thing, “only” a physician. Yes, I am a board certified physician. But I am also a degreed (Bachelor’s) fitness professional, professional athlete (IFBB Pro), certified nutrition coach, writer, model, brand ambassador and contest prep coach. If that’s too much for one to process, too bad. Because I am ALL of those things, and then some. I am just as much about fitness, bodybuilding and wellness as I am about medicine, and I shouldn’t have to choose one over the others. I am damned proud of what I have accomplished in bodybuilding, especially because I was in my forties when I took things to the next level, not when I was a young whipper-snapper, and I was already established in my medical career. I will not apologize to people who are confused by the sampler plate philosophy by which I live and who don’t believe that it’s possible to be more than one thing. Truth is, I live as what Marci Alboher describes in her book One Person Multiple Careers as a Slash, and I am proud of it. I know it’s unusual, but why is that so hard for people to grasp? I mean, here I am, doing all that I do, switching gears constantly, and sending a message to the world that no one should have to be one-dimensional and boring.

I am honest. I have sass, and I speak my mind. I will NOT hide parts of myself which some overly judgmental people may have a problem with. I am NOT going to apologize for having a sense of humor, for using cuss words here and there (though I don’t use them while seeing patients). I am not going to paint a false picture of who I am. If you don’t like what I am doing, no worries. Move on.

Here’s a message to you if you find that you are someone who is compromising your own vision, dreams, or goals, because you perceive a need to choose one thing to define you. Perhaps you need to re-examine why you are allowing that to occur. If you subscribe to a no limits philosophy, then you would never even consider pulling the reins back. I will always encourage driven people to go for whatever they want, and if it doesn’t fit in with the conventions of one of their chosen careers or hobbies, even better. Break stereotypes and show people what you are made of! Don’t hide all the facets which make you who you are!

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