Friday, February 06, 2015

the best option we've got

It took me 11 years and 8 months to get two extra letters after my name. That’s 4,179 days and almost $200,000 to earn the title of “doctor” and get one of those fancy pen stamps that represents the most-used tool for those of us in the order-signing practice of medicine.

I tend to be on the “granola” side of the large gray line in my profession. If we took a not-so-equal split and divided all the healthcare providers into two sides, I’d fall on the “less is more” category that favors conservatism, supplements, nutrition, and risk assessment (instead of the more statistically brained, medication- favoring other group). I tell my patients to eat grass fed beef and sip sparkling water instead of soda. Half of them don’t listen and balk at my insistence that their nourishment actually makes a difference in their health. But I tell them anyway. And I sign off on lab results that show borderline lipid levels because I know that pharmaceuticals cannot change lives and levels as much as healthy habits for most patients.

This week I spent two days with my young kids at home wiping snotty noses and changing poopy diapers. And I also spent three days in my office; I saw over 65 patients and signed my name-with-two-extra-letters more than I’d care to remember.

 A beautiful 43 year old with jet black hair and flawless skin sat in front of me with a furrowed brow and concerned look and asked me about her cholesterol. A 58 year old female with advancing osteoporosis wanted to know why she had brittle bones despite her lifetime of activity and healthy eating. I saw a 2 year old and a 92 year old, representing the range of life and lifestyle and living.  

In most respects I am a well-trained, well-read, well-educated Family Physician. I subscribe to nationally recommended guidelines in my practice. I use motivational interviewing techniques. I discuss risk assessment and polypharmacy with almost every patient. I believe in intervention when it’s needed and a hands-off approach when it’s not. I believe in the marvels of modern medicine and the old-fashioned art of patient exams. I believe in cardiac stents, laminectomies, and radical mastectomies. I believe in genetics, in research, in bettering the good that we’ve already got in Western medicine. And deep down I truly believe that, just like Loretta Lynn sang in her southern drawl, we’ve come a long way, baby.

Which is why I surprised myself when I didn’t want to vaccinate our kid.

I know about statistics. And I know about disease. And epidemiology. And modern vaccinations. I know about thimerosal (and that it is no longer in preparations). And autism (and the concern over its link to vaccination). And adverse effects. And I know what it is like to see a 4 month old with Pertussis he caught from his grandmother. And what it is like to see a 4 year old lose her ability to walk because she was one of the (very very) few with post-vaccination Guillain-Barre Syndrome.

I also know that needles hurt. And that post-vaccination fevers are no fun. I know sleep deprivation and the mind-numbing exhaustion that comes with crying babies after shots. I know the concern over injecting something irreversible into a clean, pure, breastfed kid. And I know the anxiety that comes with injecting six-somethings AT ONE TIME into an innocent little baby. I know that we live in a country where school aged children don’t die from measles, the County Fair is (usually) an okay place to take your 6 month old, and polio is a thing of the past. I know that, for me, taking the advice of a large governing body (i.e., the Center for Disease Control) is sometimes harder than listening to our own doctor. And I know that my own fears about Ebola and parasite-infested drinking water are piqued more by the pretty newscasters at night than they are from my 13-pound medical textbooks.

I know these things because I am a trained physician…and I am a mom.

My generation of physicians has been spoiled. My generation of mom’s has been spoiled. And the truth is that I have been spoiled, too. We’ve been falsely lead to believe that our own opinions about medicine trump the research, that our own fears about side effects might make them come true, and that the advice of those large governing bodies are filled with conspiracy and ill intent. We’ve been subconsciously convinced that feeding our kids the wrong type of baby food might make them fail kindergarten (it won’t), a cold lasting more than 7 days needs antibiotics (it doesn’t), and leaving your children in the car for 3 minutes while you return your shopping cart might get you arrested (who knows). I’ll readily admit that despite my training and my experience, despite those two extra letters after my name that make me authorized to give solid evidence-based advice to my patients, despite all the studying I’ve done, I still cringe when it comes to shots.

I told my patient with slightly elevated lipids to come back in a year. She doesn’t need the risk associated with medication right now. Lifestyle and nutrition changes might not make a giant dent in her lab results, but it is the best option we’ve got.  I told my patient with osteoporosis that we have medication that might help her bones. The medicine is designed to halt the progression of disease. They aren’t perfect medications and they are fraught with potential side effects, but they are the best option we’ve got.

And THIS IS THE TRUTH: When it comes to foods, garden is best, organic is good, fresh is fine. Buy the baby food that is on sale and take your kid to a juice bar with the saved money. Nourish your child

Put your phone away, get off WebMD, stop reading Jenny McCarthy’s books; engage your kid, play dress up, toot some trains around the house. Invest in your child.

And despite everything floating around the media, vaccinations are good. They are backed in research, statistical success, and positive epidemiological transformation unlike any other public health movement (aside from using toilets, but I think we are beyond that…). I won’t deny the side effects. Or the post-vaccination fever. Or the screaming that comes when your kid is poked. So protect your child

We vaccinated our kids.

The truth is that most of this argument isn’t about vaccines at all. It is about kids. And health. And very real disease (that has recently made a comeback). And it is about parents doing what they think is best for their kids.

Maybe it is time we all stand in that gray area together. The physicians losing a bit of our objectivity and looking concerned parents in the eye, recognizing that vaccines can be scary stuff. The parents giving up a bit of our subjectivity and listening to educated professionals who care about our kids, recognizing that vaccines are lifesaving miracles…sometimes with side effects. And in the best world, both sides coming together to admit that, although vaccines aren’t perfect, they are the best option we’ve got

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