Yes, medicine is a life’s work. But so is mothering. Working part-time is choosing to excel at both.

Every one of the docs in my internal medicine practice is part-time. Yes, many of us have other non-clinical work responsibilities in administration, education, or research. But no one sees patients for more than six sessions weekly.

What does that mean? A session is a morning or an afternoon in clinic, usually about five hours, seeing between eight and twelve patients. I work four sessions a week, so, I’m seeing about forty patients over roughly twenty hours. What would full-time be? Eight sessions, so about eighty patients over forty hours.

What’s fascinating is that a recent research article showed that for us, each hour in clinic equals about two more hours at the computer or on the phone. These findings support prior studies (and sound pretty accurate, based on my own experience): for every one hour physicians provide direct clinical face time to patients, nearly two additional hours is spent on documentation, followup, and other desk work.

So my measly twenty hours in clinic pans out to sixty hours of work. And this, my friends, is what is considered part-time, in Doctorland.

Still, I consider myself lucky that I am able to work ‘Doctor part-time’, because at least I have a chance to pursue my dream career, AND be a parent. I forget that most doctors do not have this opportunity, and if they do, it doesn’t come easily. A recent essay written by married physicians Warren and Marsha Holleman for Kevin, M.D. reminded me that many part-time doctors face criticism.

In the essay, these docs describe that when they tried to work full-time, not only were they miserable and exhausted, they were not able to be decent parents OR provide quality care for their patients. When the both of them reduced their office hours, their family benefited, and so did their clinical work. Though they felt guilty, and often faced the judgement of their peers, they learned that it was a great choice for them, and their patients.

What they describe makes perfect sense to me. Work/life balance is so important. Part-time is not a selfish choice; it’s the healthier choice, for all involved.

But that choice is often attacked. A 2011 New York Times Op-Ed titled “Don’t Quit This Day Job” specifically (and viciously) ripped apart women physicians who opted for part-time clinical work. The author, who is an anesthesiologist and a parent, worked full-time, and strongly felt that everyone should be just like her. The conclusion she made:

“Medicine shouldn’t be a part-time interest to be set aside if it becomes inconvenient; it deserves to be a life’s work.”

I remember reading that essay and feeling sucker punched in the gut. I thought: If I could work full-time and do a good job, heck, I would. Bigger paycheck, and no crap from mean chicks like you.

But just like the Hollemans, I knew that if I was full-time, I wouldn’t be my best at work, or at home. (And I certainly wouldn’t be writing, either.) As they conclude in their pro-part-time essay:

“Never for a moment would we presume to tell others what to do. All we can say is: Make those hard choices based on your values and priorities. Not on the expectations of your boss and your colleagues, and not on the culture and customs of your friends and family. Then, when you’re living out those values and priorities, you’ll be sane and happy. And when you’re old, you’ll have no regrets.”

And here’s what I say: Yes, medicine is a life’s work. But so is mothering. And when I choose to work part-time, I am choosing to excel at both.


“Surgeons Are Red, Psychiatrists Are Blue”; I’m Voting Democrat, How About You?

My colleagues have been buzzing about this New York Times article reporting the political leanings of doctors. Researchers at Yale merged two databases: one of U.S. physicians by specialty, with another of every voter by party affiliation, and found some very clear trends. 

Why did they do this? Who knows, but it’s been fun on social media (check out this NEJM blog post by infectious disease doc and funny guy Paul Sax).

But seriously, this is interesting stuff. Generally, the surgical and procedural subspecialists (read: higher-paid) are majority Republican, while most primary care and internal medicine (thinking-type) subspecialists are Democrat. 

They also present data on physician specialty and salary by political affiliation, which supports other studies I’ve seen and written about.  Doctors that are paid more tend to be Republican. 

The odd exception seems to be family medicine, a primary care specialty that is among the lowest compensated, but largely Republican. The authors hypothesize that they lean right because many FP’s own their own practice, so they are essentially small business owners. 

Given this contentious presidential election, the abysmally underqualified  Republican candidate, and what’s at stake for our democracy, however, I find it hard to believe that any physician would vote Trump. Maybe I’m overestimating my colleagues, but I would think that anyone who surpassed all the requisite intellectual hurdles and multitudinous years of education would just be, well, smarter than that. And nicer. 

But, I’m not picking arguments. The data is interesting and the hypotheses are fun. I know who I’m voting for. 

Gotta run! 

Clutter, Dirt, and Bacteria: Oh My!

Our house is a mess. Two working parents, two small children, and two cats pretty much guarantee the place is consistently gross. This doesn’t bother me much, though Hubby and I marvel at the grossness sometimes. I wrote about this on the mothersinmedicine blog, complete with color photos of our grimy bathroom. The feedback was reassuring: one doc admitted to walking by dead roaches on her floor day after day because she just couldn’t deal. Love it!

Another doc had wonderful advice:

I am highly tolerant of messes too, by necessity. It comes down to making choices… Are you going to spend the very little time you have, the precious irreplaceable time, with your kids baking, or making sure everything is neat? My five and three year old girls remember the projects we have done. They have yet to tell me- ‘mommy you were so good to wipe the handle after I messed it all up with paint’…. I think you have your priorities straight. Be proud of yourself.

Yes, we love to cook, and we make HUGE messes. Yes, our place is cluttered and grimy, but I’m not worried about it. After eleven years of clinical training, including three in an infectious disease clinic, my cleanliness philosophy is: “Who cares? We’ll all be fine. Just wash your hands before you put them near your face.”

And a recent article in the New York Times titled “I’m a Doctor. If I Drop Food on the Kitchen Floor, I Still Eat It” backs me up on this, with good data. The author, a professor of pediatrics and a science writer, describes that the things that carry the most and worst bacteria are not the things that we usually worry about. Data shows that things like cell phones, money, ATM machines, gas pumps, remote controls, and light switches are pretty disgusting. Dirtier than most toilet seats, in fact, in terms of numbers of nasty bacteria.

But most of us will hand our contaminated dollars to the very nice young person at the register of our favorite takeout place, accept a handful of frankly infested coins as change, jam it into our colonized purse, and then use our filthy, unwashed hands to eat that food, without thinking twice.

What’s his take on it, as a physician? Besides recommending the very effective and simple act of handwashing, he says:

People react to news like this in one of two ways. One is to become paranoid about everything. Such people start to clean compulsively, worry about all the things they’re touching, and use hand sanitizer obsessively.

The alternative is to realize that for most of us, our immune systems are pretty hardy. We’ve all been touching this dirty stuff for a long time, without knowing it, and doing just fine.

That’s right. Clutter, dirt, bacteria: Who cares? We’ll all be fine.

Just wash your hands before you put them near your face.

Cooking With Kids: Banana Bread Muffins 

What do I like to do with time off from clinic? Cook! And we did lots of family cooking this Columbus Day weekend.

Today when Babyboy wanted to watch television, I asked him if he’d rather help me make Banana bread instead. “I need someone to mash the bananas,” I tempted.

Sold. He’ll take any acceptable chance to smoosh things.

And I love an opportunity to use up past-its-prime produce, and sneak more healthy into the kids’ diet!

We’ve adapted this from a basic banana loaf recipe. It’s super- moist, and (slightly) more virtuous. Muffins are way better than loaves for serving and portion control, as well as kids’ sensibilities.

We had alot of bananas, so we ended up making thirty or so muffins. We’ve gotten good reviews so far, but these are going to the office with me tomorrow, so we’ll see what the real food critics think!

Banana muffins:

6 overripe bananas (you know you can freeze them until you have a chance to use them)

1 cup canola oil

2 teaspoons vanilla extract

4 eggs

1 1/4 cups brown sugar

1/2 cup honey

3 cups of flour

1 cup quick oats

1 1/2 teaspoons baking soda

1 teaspoon salt

Streusel topping

1/2 cup brown sugar

1/2 cup quick oats

1 tablespoon canola oil

Preheat oven to 350 degrees. Put your paper liners in your muffins tins. Get two good-sized mixing bowls and one smaller bowl out, a wooden spoon, and something for smashing bananas. Go crazy with that. Babyboy insisted on working from the countertop!

You only need a wooden spoon here, no electric gadgets. Mix together all of the wet ingredients (everything up to the flour) really well. In the separate bowl, mix together your dry ingredients really well. Add the dry to the wet, but only mix until everything is just moistened.

Make your streusel topping by throwing those three ingredients into a small bowl. With a small measuring cup or ladle, pour batter into each cup to about 3/4 way up. Then, sprinkle a small amount of streusel crumble over each.

Bake at 350 degrees for approximately twenty minutes. These are very moist, and you can err on the side of overcooking. How to tell when they’re done? The wooden skewer or knife trick won’t work here; when you can press very gently down on the top and it springs back, leaving no indentation, they are done.

Babyboy ate two right off the bat, and without butter!

These ARE pretty tasty, if I do say so myself. Could healthier substitutions be made? I’m sure. Maybe apple butter for oil, higher-protein flour or nut flour for white flour, molasses for brown sugar. I enjoy messing with recipes, and no doubt some variation will end up at the office sooner or later!

Cooking With Kids: Protein-Packed Berry Pancakes

As a doctor and a mother, I’m always looking for ways to sneak “healthy” into the kids’ meals. This morning, Babygirl and I mixed up some high-protein berry pancakes, which sounds healthy, and probably would have been even more so, except that she insists on dipping each individual bite into her custom maple-syrup-and-melted-butter sauce.

For the parents out there who want to know how to turn pancakes into a breakfast you can feel good about, here’s my EASY recipe:

First, start with a high-protein pancake mix, like Kodiak Power Cakes (and no, I do not get money from those guys, it’s just a good example). Then, when you mix it up, use milk instead of water. Throw in a good amount of frozen berries, like blueberries. We used a mix of blueberries, raspberries, and blackberries.

Kids can handle everything up to this step:

Meanwhile, you’ve been heating your pancake pan on “low” heat for at least five minutes. When you’re ready to make these pancakes, swipe some butter on there to grease the surface, or use a spray canola oil. Use a measuring cup or ladle to pour out pancakes of your chosen size, and my trick is, cover them so that they cook more evenly:

You know they’re ready to flip when they lose their wet sheen and get kind of dull, as well as a little bubbly:

Serve’em hot. Watch your kids happily inhale their yummy meal of protein and fiber (and, perhaps, a small lake of maple syrup with globs of butter). But feel good about it!

Good Deed Of The Day

Image result for image baby screaming

Friday six p.m. I had had a very full clinic day and was on call for our practice. I was BEAT but I sprinted in hard rain to the station to catch the train I could see coming, so that I could get back to my car, drive to my mom’s, have family dinner, and then herd my kids home to their bedtime ritual.

I made the train, though somewhat soaked. My mind was fried but I stood there flipping through the days’ news, and especially the latest from Syria. The CNN video of a white helmet volunteer sobbing as he rescued a two-month-old baby from the rubble of a bombed civilian home caught my attention and as I watched it, I tried not to cry.

I glanced up from the video to see if anyone was noticing that my face was getting that scrunched-up-blinky-eyed-tears-about-to-fall look, and I realized that everyone was staring at someone else entirely.

At the far end of the train, a mom sat with a toddler in a stroller in front of her, and the toddler was SCREAMING. Not whimpering or even steady crying, but harsh-throated howls accompanied by full-on flailing and kicking. He was probably two, two and a half years old, and just miserable. His hair was plastered damp with rain and sweat. His mother was trying, but not able to calm him. She had a hopelessness about her, like she had been trying to calm him for a long time.

And my fellow commuters were being total assholes about it. In one quick scan of the crowd, I caught several eye rolls, a few deep annoyed sighs, a couple of older women pointing and whispering, and even one person covering their ears. The rest buried their faces in their phones, the way I had been.

I only just noticed the situation, not because it could be easily ignored, but because I have this weird (but handy) ability to completely block out my surroundings no matter what is going on. This has enabled me to study and write in the most unlikely situations, but, I have also missed overhead pages, cries for help, and at least one flight.

Once I could “hear” this kid and “see” the drama, I was completely attentive. Not because I was bothered, but because I wanted to figure out how I could help.

The poor mom was obviously at breaking point. She was wearing a gray hoodie pulled up over her head, like she was trying to hide.

Please stop, please stop,” she begged her son, as she pushed the stroller back and forth, not in a soothing way but sort of jerkily. “Stop screaming. Stop. You need to stop,” she repeated over and over. Her face was tense.

Then she put her hand over his mouth, which alarmed me but definitely alarmed the child even more. His face panicked, eyes wide, like he was being suffocated. When she took the hand away he took in a great breath and SCREAMED.

Holy moly, someone needs to get in there, I thought. What do I have that’s entertaining? I rummaged through my purse, but there were no stray kid things.

Then it hit me: I have an iPhone, and I have the PBS Kids Video app!

Now, I don’t get any money from PBS, but I love them. My son uploaded this app so that he could watch cartoons like Curious George and The Cat in the Hat. I quickly opened it up and made my way towards the situation. I held the phone out in front of me and let it just play. Peg and Cat, a STEM (science, technology, engineering, math)-inspired educational cartoon came up.

Thankfully, I had good reception, and as soon as that thing was within hearing distance, the screaming magically stopped. I literally just stood there holding my phone in front of the baby’s face and watched him transform from terrified misery to curious contentment.

It occurred to me that his mom may not be a television fan, but she only collapsed back in her seat and, voice cracking, exhaled: “Thank you.”

“Oh, I only have this on my phone for my kids, I’ve definitely had similar experiences with them!” I offered, cheerfully.

She seemed to be searching for words, and I realized she was fighting back tears. “How… old are your kids?” she asked, in a whisper.

My heart went out to this woman, who was hopelessly beyond exhausted. I didn’t want her to feel like she had to expend any mental energy in polite small talk.

“They’re six and four, and boy, do they grow up fast! I love your boy’s curls. He’s adorable,” I gushed. She just nodded. “I hope you don’t mind the cartoons…?” I added.

“Oh, no, please, it’s great. We watch that one too.”

At that moment, a man nearby called out, sort of loudly: “Thanks, the ride is much more pleasant now! Glad you were here! Thank goodness for cartoons!”

I turned around quickly with the intention of saying something like I didn’t do it for your benefit, buddy and then I realized, the man was developmentally delayed. He then went into a long commentary about Public Broadcasting and cartoons in general.

The mom and I sort of listened and smiled, and I think she was thankful to be able to just sit, listen, and not talk. The baby was engrossed in the videos, only occasionally glancing up at me, and when I gave him a big exaggerated smile, he smiled back.

That was how I spent my commute home, and when it came to my stop, I apologized and got off. I was expecting to hear disappointed cries, but all was well.

I can’t do much for the suffering families in Syria beyond praying and donating money to charity, and I feel angry, sad, and helpless about it. But I was able to soothe a crying toddler and offer support to his struggling young mom, and for that small, concrete act, I feel pretty good.

Note To Potential Thieves…

Image result for cartoon messy house

True story: Yesterday afternoon, I left work around five-thirty p.m., went to my mom’s, picked up the kids, and drove home. Hubby was still at work. I walked up our back steps, and was alarmed to find the screen door unlocked, and the back door wide open.

Our town has had numerous daytime break-ins recently. One last week even involved a television-show-style foot chase of multiple perpetrators by a squadron of law enforcement personnel. Our police department posted an exciting play-by-play description of the whole thing on their Facebook page, ending with:

“In time, we were able to apprehend all 4 suspects. They were all arrested and charged with multiple offenses.”

Even though those guys were caught, I was anxious, thinking: Did someone kick the door in and rob us?

The kids were running around in the backyard, so let them stay outside, and I tentatively pulled the screen door open to peek in.

The first thing I saw was our kitchen “everything” drawer pulled open and things like pens, flashlights, gift cards, paperclips, and coupons strewn all over the counter and floor, along with the kids’ artwork, markers and crayons, various mismatched shoes, and reusable grocery bags. You could barely see the hardwood, there was so much junk on the ground.

I gasped. “Oh my god, someone’s broken in and rummaged through everything looking for valuables!” was my immediate reaction.

Heart pounding, I turned back to check on the kids and wondered what to do first. Call the police? Walk through and see what may have been taken? Call the neighbors?

Then, I remembered.

Hubby had had to take both kids to an early-morning doctor’s appointment downtown. He had texted and called me in a panic, because he’d got a late start and was stuck in traffic, and then only got to the specialist’s an hour after the scheduled time.

It dawned on me: This was not the work of burglars. This was the work of two small groggy children and their frazzled dad trying to get out of the house on time for that appointment.

Confident now, I strode through the house, investigating, looking for anything missing, just in case I was wrong.

Then, I remembered.

We don’t really have anything for a run-in-and-get-out thief to steal. The kids’ iPad was with them, our phones and laptops were with us. My only good jewelry is on my hand, and everything else is in a safety deposit box at the bank (Superbowl ring too, FYI). The flat screen T.V. is the only thing on the first floor that’s worth something, and it’s probably outdated and outmoded by now, plus it’s way too big to escape with, unless they had two guys and a pickup truck handy.

Note to potential thieves: Unless you’re REALLY into Legos, quality used cookware, and sports nonfiction, don’t bother with our place. You would also have to contend with our mean cat. It’s not worth your time. 

When Hubby got home, he was very sheepish about leaving the house like that.

Note to potential thieves: We won’t be leaving the door open again anytime soon.