Redefining success

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Yesterday, I posted a response to an article in Cosmo that bugged me. I posted it here, on my little blog, the one whose most loyal reader is my mom. (Hi Mom!) Then I went on my way.

I had the day off, so I had a girl date scheduled: mani/pedi followed by lunch and maybe a grown-up drink. Of course, when you have a baby in tow, girl time looks a little different – 15 minutes late, I blustered into the nail spa’s oasis of zen, stroller and diaper bag overflowing. Other midday mani customers (a niche demo if there ever was one; I observed several unique examples of leopard print) looked up at me and gave the side-eye. Yeah, yeah. Back to your nails, ladies.

I settled in and glanced at my phone. Notification from WordPress: “Your stats are booming! Looks like Love and Ladybits is getting lots of traffic.” Huh. That’s weird. But good? I guess?

By the time our visit to the nail spa had come to an end, the baby had charmed the pants off every leopard print aficionado in the place, my fresh manicure was already completely trashed from fumbling around in the diaper bag for random objects to be used as baby toys, and my morning diet of coffee followed by more coffee plus polish fumes was starting to make me woozy. We headed off toward lunch and I glanced at my phone again. It appears that my blog is getting comments! And people are tweeting about (at? still unclear) me! But being the good girlfriend that I am, the phone was stowed away until the final bite of birthday brownie had been consumed.

And then I started reading the comments.

Look, people. I just started this thing because it’s cheaper than therapy. Earlier this week, I talked about my (highly questionable) decision to eat leftover cake out of the trash. Then I blogged about my (highly questionable) decision to read Fifty Shades of Grey. I’m not pretending to be WebMD, or even Cosmo. Yes, I’m a health care provider, but I’m also a human being, and I’m entitled to have human opinions and human emotional responses like everyone else. So when I read something I disagree with, I’m allowed to respond however I want.

It’s kind of like that time when I was 22 and my pill was changed on me for some obscure HMO-related reason. I didn’t love the way the new pill made me feel, so I asked the doctor with the soonest available appointment to change it back. He refused, and gave me a prescription for Prozac instead. Nice.

Did I complain about it? HELL YES. It also taught me a few lessons about the type of provider I hoped to become someday. And I haven’t stopped complaining, and learning from the things I complain about.

The irony of my being called the many, many names thrown at me over the past 24 hours is that I’m actually one of the most patient-centered care providers I know. I practiced shared decision making before it had a name. I have a comprehensive list of hormonal and nonhormonal contraceptive methods that I review with everyone, even the patients who come to see me specifically to start the pill. And when a patient asks to change her method because she doesn’t love it, we work on it together until we find something better for her.

That might be because I still remember exactly what it felt like to be a college student. I felt like I knew everything and nothing, often at the same time. I’d start a feminist activism group on campus, and then miss entire weeks of class because MTV decided to run a Real World marathon. I had fierce convictions and boundless potential but not always the best follow-through.

I see that in my patients, and I get it. It’s part of why I love this population, and part of what drives me crazy about it, and all of it is 100% developmentally appropriate. Telling an 18-year-old who’s barely figured out how to use a tampon to check her cervical mucus is asking a lot. Expecting someone who doesn’t own a thermometer and doesn’t know what a fever feels like yet to reliably monitor her basal body temp is asking a lot. I’m not saying fertility awareness methods are impossible for the informed and highly motivated teenager, but it may not be right for every teenager. It certainly wouldn’t have been right for me.

And isn’t that the awesome thing about being a woman of reproductive age today? We have choices! Lots of them! This is a good thing!

Which is why it didn’t occur to me that writing a pro-pill (but really more of an anti-anti-pill) post would inspire the level of vitriol it did. I mean, if it had been coming from angry Catholics, I might have been less surprised. But it didn’t. For the record, the tone of this blog has nothing to do with tone I use with patients, and I promise that I’m not “pushing” anything…except informed choice.

Anyhow, as I get back to my role as cog in the of the woman-oppressing patriarchial/big pharma machine, I’ll sign off with the observation that I now seem to have more readers than just my mom (no offense, Mom!). And that’s certainly something.

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9 thoughts on “Redefining success

  1. I’m glad to hear it 🙂 I think (I’m speaking only for myself here) that the post just came off as very ANTI everything but hormonal contraception. In this day of pushing LARCs, when many many women don’t do well on them at all (and they have all been shown to have pretty significant health detriments, especially when started very young.

    I think we all want what is best for women in general, and that comes out as how best to support and educate them in whatever decision they make and not trying to restrict access or not take concerns seriously.

  2. as health care providers, we have to be aware that our opinions carry weight. You may be just “blowing off steam,” but a patient may have stumbled across your article and taken it as absolute truth. Yet, you based your critique of FAM off of a limited knowledge, which is evident by the way you talked about it. You could have turned someone who would benefit from it away because the public TRUSTS us licensed professionals.

    The attitude you have about teaching teenagers is so paternalistic and prevelent in healthcare. We think, man that’s hard, our patients couldn’t handle it, so we won’t even bother telling them or we’ll dismiss it to them. Well, maybe they couldn’t, but maybe they could. If we can expect T1 diabetic teenagers to check their BS, adminsiter insulin, and monitor carb intake, we can at least try to teach teenage girls about their bodies. They deserve to know their options and to have them given in a non-sarcastic manner.

    • Since you’re a graduate nursing student, I would encourage you to consider the importance of keeping an open mind when it comes individualizing care with each of your patients in the future. You might be surprised to find out that they don’t always agree with your opinion about what’s best for them.

      I’m not sure if I can say anything to you that you’ll listen to at this point, but I don’t actually think we’re that far off from each other, if you’d be willing to read what I’ve written with an open mind. We agree that providers that refuse to listen to their patients aren’t okay. We agree that presenting all available BC methods is the goal. So….?

      I’ve actually stated twice now that I don’t have a problem with patients who choose FAM for themselves, and that I present all possible BC options to my patients, but I truly do understand where teens who decide they’d rather go with something besides FAM are coming from…because I’ve been there myself. Just saying I get it; not saying this translates into pressuring anyone into anything. But I get it.

      I can’t help but wonder – how is your position, that you know what’s best for your future patients when it comes to OCPs, any less paternalistic and patronizing than what you’re accusing me of? Just wondering, since we’re both health care providers here, right?

      • I haven’t said that I would force women to only use FAM, so not sure where you’re coming from there. It’s funny that you are preaching individualizing care and open mindedness now after you nastily ridiculed the original post for choosing not to use BC because she did not feel it worked for her.

        I’m not going to pretend like OCPs don’t exist or give them five minutes of bs about them. I won’t blog about how my patients are too incompetent to learn their bodies to even bother teaching FAM. I’ll tell my patients about all the options, and I never said I wouldn’t. they’ll decide. But am I going to prescribe them ever? Honestly, no. I can direct them to someone who will, but with all I have learned about them and experienced personally and through friends and family, I’d be doing women a disservice and I’d be a hypocrite. You can sneer at that, but plenty of physicians and NPs do not prescribe medications they think are dangerous. That’s my choice. I’m not preventing anyone from getting it, they just won’t get them from me.

    • Sam-
      You are saying you will not prescribe a medication you feel is “dangerous.” The question is, is this a personal sentiment, or are you deciding this out of your medical training and understanding of pharmacology? There are specific dangers associated with OCPs and specific situations in which those dangers are most relevant. In the majority of situations, however, those serious dangers are minute. You must regularly as a medical provider ask yourself if you are doing something in your own interest or in the patient’s interest. I would encourage you to think more about that as you continue your education.

      p.s.- I hope you do not believe that the tone healthcare providers take in individual online blogs is the way they address their patients in the office. I suppose perhaps you are not yet deep into clinical, or you would know to not make that assumption. In the same way, I don’t expect (and dearly hope) that the way you respond to these online blog posts is not the way you will interact with patients in the office once you are yourself a clinician.

  3. The thing is – the upshot of this whole attitude of “young women aren’t responsible enough to deal with this info because they’re too impulsive/drunk/vulnerable” is putting ALL young women on LARCs – which is exactly what we’re seeing a move towards. We’re now hearing they aren’t responsible enough to remember to take a pill every day (something pretty simple) so OF COURSE you’re going to say they can’t handle checking their temperature. It smacks of Victorian paternalism – like saying young women shouldn’t learn to read because it’s too much for their systems! There are studies that suggest teaching teen girls and boys about cycles and fertility signs increases self-esteem, confidence, responsible choices, and betters gender relations. It makes sense. They should, as a rule, be using condoms to protect against STIs anyway. Body literacy provides the foundation for informed choice – a young woman may then choose to use the pill or a LARC but at least she would know how it worked, how it might impact her body, and also that there are other options to prevent pregnancy. She won’t be coming from a place of fear and she may even be more likely to be successful with her choice because she will have this knowledge of her fertility. How much pressure is put on young people these days to achieve in school? So much. We expect them to master everything to even get a chance at a place in a college, and yet you don’t think they can master learning about fertility signs? I suspect if a young woman has got to your college and walked into your clinic she is more than ready to be presented with all of her options. Let’s not forget the pill has high discontinuation rates, low satisfaction rates and the answer to this is not more hormonal options it is providing effective non-hormonal choices. Anything else is doing a disservice to young women.

    • You know, if you’d like to just keep these comments on your book’s Facebook page, where you and your minions are posting the exact same statements you have been here, please feel free to do so. I’d hate for you to duplicate your efforts unnecessarily.

      Nowhere have I stated that I would refuse to discuss, and provide teaching when the patient expresses interest, in FAM. On the flip side, one of your followers has admitted she will blatantly refuse to prescribe OCPs to her patients when she becomes a prescriber herself someday.

      Now, tell me again who’s being close-minded and arrogant?

    • Holly-
      I think you will find that we are very in favor of teaching and enabling women. What we have that you seem to be missing is realistic understanding of how much can be taught in how much time, and the real risks involved (you also seem to be missing the p.s. part of her initial post where she mentions the still-atrocious rate of sexual assault against college women). We are not being patronizing. This is not a decision that is yours to make- THAT is patronizing. It is up to each and every patient and her provider to decide what is their best option, and again, to then follow up to find out how it is working. But you seem to imply that women should be getting medical counseling from a blog or a book or a magazine instead of from a helpful medical professional- and that is just plain wrong and dangerous, not to mention a serious disservice to young women.

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