Monthly Archives: November 2016

America Has No Idea What They’re Eating.

I recently started working 1:1 with a nutrition coach.  I’ve always been a healthy eater.  Recently,  I’ve cut out sugar and focused more on healthy foods and timing of nutrition.  When I felt I had done all I could on my own I hired a coach for a few months.

Now I’ve weighed some foods before and eyeballed even more.  Let me tell you the first time you weigh or measure peanut butter or almond butter you question everything you ever thought you knew.  And then you cry just a little inside and out.

I look at the portion sizes people take in and scream and die on the inside.  People literally have no idea what they are eating.  In turn, their kids also are not learning what they are eating.

One of the women on the facebook page for the nutrition program I follow (Working Against Gravity) posed a question if other Moms in the group worried about what their kids though about them weighing and measuring their food.

At first I was like eeehhh good point.  Then I thought a bit deeper.  I thought to myself “This is a great teaching opportunity!”

Kids take in so much from their parents. Food, eating habits, nutrition and wellness are no different. I figure it this way, parents who weigh and measure their food can potentially cause the same harm or good as the parents who quadruple the dosing for their children.  It is all about the perspective.

The way I look at it is for parents who are healthy and weigh and measure food, they can teach their children about what is necessary in order to properly fuel their bodies and grow up healthy. Teach them what veggies, healthy protein and carbohydrates are and what they do for their bodies and mind.

Not teaching children about healthy portion sizes and food can have just as much if not more a detriment than showing them that it matter.  It results in kids growing up not being able to identify what broccoli or cauliflower is, or eating 16oz of pasta when a serving is 1/2 to one cup, eating 10oz of steak or chicken when 2oz gives you 15 grams of protein.  10oz of meat= 75g protein.  CRAZY!  My daily requirement on any day whether it is a rest day or I’m in the gym being active for 2-3 hours is 120g.

Like I said, people have NO idea what they are eating. As long as we as adults have no idea what we are eating– we pass that same message on to the next generation.  I guess my final statement is that we shouldn’t shy away from teaching kids about healthy eating.  If they don’t learn to form healthy habits, it will likely result in unhealthy habits and behaviors.

Healthcare Culture: Everything Hurts and I’m Dying

There are a lot of issues being discussed in healthcare today.  One point I don’t hear a lot about, but see everyday comes directly from our patients mouths.  They come in to clinic with the mindset of “everything hurts and I’m dying”.  What this means is that if they have a headache they think and know that they have a brain bleed and they need and MRI.  If their child has a cough they definitely need an antibiotic.  They woke up sick this morning or have an ache in their shoulder x1 day: everything hurts and I’m dying.  

The undertone of this statement that they don’t directly say: And you BETTER do something– better yet– what I think you need to do. 

Now, let me be clear it isn’t that I’m not empathic to patients who are feeling ill or in pain.  However, there is this culture out there that extreme measures, investigations and treatments need to be taken if you have a headache.  Are there the small percent of people who do need these measures? ABSOLUTELY.  That is why we do history and physical exams to weed these people out and send them for these tests.  

Why does this matter? What is this causing in medicine? Cost. Waiting room lines. The emergency department being used for non-emergencies (sorry people this was not created for you to get a pregnancy test free or score some morphine for back pain– it was meant for people with asthma exacerbation, CHF, PNA amongst so many others). 

How does this effect providers? We also have to act like someone who thinks they are dying are dying.  If we don’t they’re not satisfied. Re-assuring patients has become the most difficulty part of my job.  We all know when we have this person in front of us.  I always make sure to do a full physical exam.  I talk them through it saying “your ears are clear–no infections, airway is patent– tonsils are not enlarged, no lymph node enlargement, lungs sound great, your neurological exam is completely normal, vital signs completely within normal limits—– etc etc”.  But for some people they just aren’t satisfied.   

What else are we to do?  Patients who push for further intervention, I tell them I cannot treat an infection that is not there or worry about signs or symptoms that you do not have.  I tell them this is good news.  

My question is where are we going wrong? It seems like more and more people are lacking basic concepts about colds, headaches and belly aches.  I do my best to educate my patients.  Viral bronchitis is a BIG one.  I tell them 98% of bronchitis is caused by a virus. The cough can last 3-4 weeks even after you begin feeling better.  I state “Scary symptoms that you DO need to be concerned about are persistent fever or coughing up blood streaked sputum.” I ask them EVERY TIME “do you have any questions”.  I usually ask this twice. Yet somehow there are still people who come back a week later cause they have a dry lingering cough?  

Would love to hear thoughts from students on rotation and practicing providers with how you best handle these situations.  As well as suggestions.  May this serve as a reminder to always educate your patients as much as possible!

Breaking Down PA School Interview Questions XII

This week also features two questions.  Thanks to Abigail for e-mailing me!!  I love when you guys send me writing topics and questions you are asked at interviews, so keep it up!

Q:What patient population do you least like working with gathering your patient care hours?

What are they looking for

  • That you aren’t going to bash anyone.
  • Bias 
  • Compassion (that you have it, duh!)

What to avoid saying

  • Anything negative.
  • A statement that is going to cluster or segregate a group of people.  (Disclaimer: the statements below are not things that I would say and in no way represent how I feel.  They are simply a way to give examples.)
  • For Example:
    • “Working with pain patients was the worst, constantly ringing the bell to ask for more pain medications and complaining”
    • “Diabetics who are non-compliant.”
    • “Psych patients, it’s not even like they have a REAL problem.  Just suck it up”

What to say

  • You really enjoyed the diversity (of whatever population(s) you worked with)
  • Mention that the diversity of medicine you were exposed to really makes you look forward to clinical rotations and learning more about all areas of medicine. 
  • Every patient is a person first and that their disease does not define them.
  •  Certain qualites can present challenges such as non-compliance, but it is all part of working in medicine and that you look forward to growing as a person and future provider.

Q: What specialty would you least like to work with as a PA?

What are they looking for

  • To see if you’ve made up your mind about what area you think you want to work in
  • If you are open-minded about learning
  • If they are a program focused on underserved populations/family care if you have interest in that area

What to avoid saying

  • You are “certain” you want to work in a specific area.
  • Saying anything negative about a particular area of medicine.

What to say

  • Mention what you liked while shadowing, but DO NOT commit 
    • For example: ” I really liked the role and responsibilities of Emergency Department and Cardio Thoracic Surgery PA’s; however, I know there is a lot for me to learn and many areas of medicine to gain knowledge and exposure. 
  • You cannot be certain because you worked in a small subset of medicine (wherever it might have been) and that you look forward to figuring out what specialty you want to begin your journey in medicine.