Thursday, January 26, 2017



How New York State can be an Island of Sanity and Compassion


Republicans have total control of the federal government. They want to dismantle our already fragile healthcare system. The New York Health Act is one way to protect New Yorkers from the coming onslaught and to guarantee everyone in the state can access the healthcare they need without financial barriers. According to an economic analysis of the New York Health Act, 98% of us would pay less for our health care. Not only is passing New York Health the right thing to do, it’s economically responsible. If all 32 Democrats in the NYS Senate would sponsor New York Health, we could get this bill to the Governor’s desk to be signed into law. We can do this! If you think healthcare is a human right, call your state Senator and invite your friends to do the same! Demand universal single payer healthcare for all New Yorkers. Demand the New York Health Act!

This Friday, please join New Yorkers all over the state in calling your state senator in support of the New York Health Act.
The New York Health Act, sponsored in the state Senate by Senator Bill Perkins, would guarantee healthcare to ALL New Yorkers regardless income, wealth, employment, or immigration status. Everyone, rich or poor, rural or urban, upstate or down, deserves access to quality healthcare.

If you agree, plan to call your senator on Friday and spread the word through your networks! The bill will be introduced shortly, so we don’t have the new bill number yet, but you can tell your Senator the bill number from last year’s session was S3525. Please help make the Statewide Call-In Day a success by calling your own state Senator and also Senator Jeff Klein, leader of the Independent Democratic Conference:

1. Calling Your State Senator. Look them up here,

https://www.nysenate.gov/find-mysenator, or dial the NYS Senate Switchboard at (518) 455-2800.

You will be asked to give your zip code and the operator will connect you to your Senator’s office. Here is a sample script: “Hello. My name is ________. I am calling to urge Senator _______ to sponsor the New York Health Act [S3525 from last session, will be introduced again very soon] this session because healthcare is a human right. With the Affordable Care Act under attack by Republicans in Congress, Senator ______ can take action to guarantee healthcare for all of us in New York by supporting New York Health.”

If they respond that your Senator is already a sponsor, say THANK YOU and urge them to promote the bill to their Senate colleagues.

Calling Senator Jeff Klein (518-455-3595), head of the Independent Democratic Conference. Here is a sample script: “Hello. My name is ________ and I am calling from ________. I am calling to urge Senator Klein to sponsor the New York Health Act [S3525 from last session, will be introduced again very soon] this session. As leader of the IDC, Senator Klein, and all the IDC senators, need to take action to guarantee healthcare for all New Yorkers. With the Affordable Care Act under attack by Republicans in Congress, it’s critical they take action by supporting New York Health.”

2. Forwarding this email to 5 friends.

3. Sharing and inviting your friends and contacts to the event on Facebook. 

4. Tweeting! Here are 2 sample tweets:
A. Stand up for #allofus in NY @JeffKleinNY Plz sponsor #NewYorkHeath to guarantee #healthcare4all regardless wealth or employment status
B. 2 million New Yorkers have no health insurance. This equals 2000 preventable deaths each year. Plz Sponsor #NewYorkHealth @SenDaveV

This is a way to get in the game and no one can afford to sit this one out.  On behalf of all my patients, colleagues, friends and fellow citizens.

Doctor Engelland

Monday, November 14, 2016

Addressing Teens and Young Adults after the 2016 Election



Many of us, young, middle aged, older and very old have questions and concerns about the election and the future of our country.

One of the most helpful things I have read is from Dr Offutt's blog.  Dr Offutt is a physician in Philadelphia with a passionate interest in reaching teens through social media.

Here is her answer to last week's events. Check it out and send me feedback on how your conversations with friends and family are going.  Most important is to keep talking and de-stress in ways we all know can work.

Speaking of de-stressing.  Here is a useful article "Breathe. Exhale, Repeat. The Benefits of Controlled Breathing" from the New York Times, published the day after the election.  Ever a fan of using breath to manage emotions, stress and sleep, I encourage everyone to practice using breath as the always-with-you method of relaxation and release.

De-stressing and relaxing are not capitulating.  Rather they are savvy ways to re-arm oneself for the terrain ahead.

William Sloane Coffin (1924-2006), a charismatic and powerful chaplain and a peace activist, once said the following:

"The world is too dangerous for anything but truth 
and too small for anything but love."


Thursday, October 27, 2016

The Gap Year Concept

Last week I was lucky to be at an Infectious Disease conference sponsored by Harvard in Boston. One of the main draws for me was Dr Paul Farmer  who was the keynote speaker.  Farmer is the subject of the book Montains Beyond Mountains and the founder of Partners in Health, a non governmental organization that delivers medical care, education, health systems and practical idealism in Haiti and Rwanda.  To be honest, his speech was badly constructed, but inspiring nonetheless.

But what was really the exciting part was standing around Farmer for the opportunity to shake his hand and let him know that I have not given up on Haiti even after the recent hurricane's devastation, the perennial postponement of elections, the cholera outbreak, the looking the other way by many otherwise generous contributors, and the incomplete reconstruction following the earthquake of 2010 (called "the event" by Haitians).

As I stood waiting my turn an earnest young physician asked Farmer how he was raised to be such an idealist and to have the values he does.  The young man made it clear that he was thinking about his own children and how to parent a potential idealist.  After a thoughtful pause, Farmer said that he wasn't sure it was anything specific about how his parents raised him but it was really his gap time before studying medicine when he was galvanized by a trip to Haiti. It was this experience that turned him to "the man who would cure the world," the subtitle of Mountains Beyond Mountains.

The day after returning home  the New York Times ran a large article entitled "How Taking a Gap Year Can Shape Your Life." As the New York Times money columnist, teh author of the story, Ron Lieber, takes a financial perspective on the idea of a gap year.  Why waste $70,000  especially if an 18 year old is not ready to profit from college.  In addition, Lieber and his friend Colin Hall sought out several of the people who took gap  years that they had profiled when they were students 20 years ago. Many of these folks attribute their current paths, successes and happiness to that gap time.  Very much like Paul Farmer.

This all makes sense.  We now know that the adolescent brain is strongly influenced by the ideas, feelings, experiences, sights, sounds and languages that it "sees" during these formative years, If gap year experiences arouse joy, intensity, fear, a sense of accomplishment, fun, and all sorts of other strong feelings, they are likely to be sought  later by a more adult person who may be seeking to replicate what the brain knows is fulfilling and meaningful.





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Tuesday, October 18, 2016

Consent in the Age of Confusion



Sexual assault, Sexual harassment, Non-consensual sex, No means No, Alcohol does not equal Consent.

These are some of the phrases one hears endlessly on college campuses these days.  For some time now this vocabulary has been taught at the high school--and even middle school level and is being reinforced to students.  But suddenly the language of consent has moved onto the front page of national papers as we head into the last three weeks of the 2016 Presidential campaign. Let's take advantage of the situation.


Adolescent and Young Adult Medicine providers of health care know that in addition to treating sore throats and STD's counselling about all matters in life is part of the job description.    Providers (who may be as young as 23) as well as patients, parents, teachers and even grandparents can benefit from the mighty resource that is the Internet. In these confusing and dangerous times there has been a flurry of activity on my professional list-serves.  Here is a curated list from Scarleteen.com that gives folks multiple avenues, resources and  approaches to the questions surrounding consent:

What is sexual consent? An active process of willingly and freely choosing to participate in sex of any kind with someone else, and a shared responsibility for everyone engaging in, or who wants to engage in, any kind of sexual interaction with someone. When there is a question or invitation about sex of any kind, when consent is mutually given or affirmed, the answer on everyone's part is an enthusiastic yes.

For a discussion about Sexual consent and the "rules of the road"

 Pediatricians Role in Sexuality Education [good read for residents]

It's on Us Campaign: President Obama's initiative on consent and sexual assault


Laci Green, YouTube Phenom; Wanna Have Sex? (Consent 101)


Consent is like tea, from the UK, gone viral



Washington Coalition for Sexual Assault Programs [Talking to Children about Boundaries/Assault Prevention for Parents]--adolescence should not be the first time youth are exposed to these concepts.


If this all seems a bit overwhelming start with the "Consent is like Tea"video from the UK.  This level of humor and analogy would even be appropriate for scout troops and middle schoolers.  The conversation about consent needs to start early.  "Tea" offers a simple analogy that can get the conversation going.

Stoplight illustration via Google images

Tuesday, June 14, 2016

Raising Ethical Boys and Girls, too

This morning on National Public Radio I listened to a call in show of parents who were invited to phone in to discuss how to raise a "good boy" beyond the "boys will be boys" mentality and to discuss how mothers talk to sons about consent.  Why now?


Here's the story: Last week, Brock Turner,  a Stanford undergraduate--a white, male, campus athlete-- was convicted of raping a young woman behind a dumpster while she was unconscious. His lenient sentence of six months in jail has been discussed in all media and even a possible recall of the judge on the case has been proposed.  

I was surprised that many of the callers were mothers of very young boys, and I tried many times to phone in to add my few cents but the line was busy.  That is a good thing.    As a mother of four young men, now ages 28-32, and three strong young women, I am very proud of all of them.  All seven kids have partners they treat well and as they hope to become parents themselves I am reminded of the rubric I used during their adolescence and with my teen and young adult patients.

When we think about healthy relationships and how we gauge whether a relationship, be it one just minted in a bar, a same sex friendship, or a long term marriage, it is helpful to have some sort of guide.  A few years ago I gave a presentation on gauging relationships to a PTA group of parents at which I distributed a small business card with six criteria for judging. Some time after my presentation one of the moms who attended and whom I knew was recently divorced stopped me in the street to let me know that she had started to carry the card and used it to remind herself of what she was looking for in a date and potential mate.

So what do we look for and what does it mean in real life? We want our relationships to be:

RESPECTFULDo you ever  feel put down, disrespected or hurt by your partner? Do you feel contempt coming from him or her?

CONSENSUAL: Do both partners consent to any activity between them?  Decisions might mean deciding between the zoo or the beach but also involve whether when and how to have sex.

MUTUAL: Both partners can expect to benefit from their relationship and feel good physically.  Sex may be a form of currency for some, but both parties can look at whether they benefit in a mutual fashion.

SAFE:  Safety should be both physical (protected from pregnancy and sexually transmitted disease) as well as psychological (check out and explore any power imbalance of age, money, sexual risk, status or life experience)

MINDFUL: The foundation of a relationship, physical and intimate or not,  should not be based on the need for alcohol, drugs or other harmful and mind-altering behaviors.

FUN: A healthy, strong relationship can be expected to be fun, to make you laugh and contribute to your happiness.


Let's teach our kids that when we buy a used car we kick the tires a bit and we expect it to perform. Relationships, even intentionally short term ones, can be rational and thoughtful to a large
degree.   And then there is love.



image captured from Google images, 6/14/16








Friday, January 10, 2014

Worried about the Twenty-something Generation? Read on

Whether you call them the Millenial Generation, Millenials, or GenerationY, those young people born roughly between the early 1980's and the early 2000's often get a bad rap from their elders.  They don't make or answer phone calls, they forget birthdays if you aren't on Facebook, they don't send thank you notes enough, and they are constantly texting (or something on their "devices')when you are trying to talk to them.

Maybe that's because many of them are busy doing important things.

For a glimpse at 450 innovative, smart, productive --and often RICH--young people, take a look at Forbes' third annual Thirty Under Thirty list.  Here is an impressive group of people, all born after 1984, who are active and creating with big ideas in the arts, entertainment, social entrepreneurship, food, and ten other categories.

The cover of the January 20, 2014 Forbes issue is graced by Evan Spiegel who co-founded Snapchat. Snapchat is an app for mobile devices that allows one to post a photo or video evanescently as it disappears within seconds of receiving it, thereby insuring privacy and intimacy, in the same way a conversation leaves no trace. Spiegel and his partner are reported to have turned down a $3 Billion (that's Billion with a B) offer from Facebook.

Or there is Christopher Atgeka who founded CA Bikes to outfit bicycles and motorbikes as ambulances in order to help rural villagers in his native Uganda get to distant hospitals for care.

Or meet Elizabeth Alpern and Jeffrey Yoskowitz who started The Gefilteria in New York to reinvigorate Yiddish cuisine.

Just browse the optimism and spirit of these remarkable people if you wonder what is going on in their young heads.  You will be amazed and find new respect.

Monday, July 1, 2013

Pediatricians' Pride:Upgrading Care of LGBTQ Youth


  
If a pediatrician sees somewhere around fifty patients a day in a busy practice, there is a good chance that she will see a youth who identifies as LGBTQ, short for lesbian, gay, bisexual, transgender or questioning.   A "questioning" youth, according to the AAP is "anyone struggling with sexual attractions and identity formation,"  according to a summary of the new policy published in AAP News.


The AAP's Committee on Adolescence has just come out with recommendations for providers on how to best approach and care for these youth.  According to the lead author of the study, the approach is that "these children...are normal; they are just different." The emphasis in the article and its recommedations is on the good general physical and mental health of LGBTQ youth.  An updated guideline helps provide compassionate care in a few special areas based on the epidemiology and social  behaviours of LGBTQ youth.  We know a lot more about them than we did even in 2004 when the last official statement on caring for this subset of the population came out.

"Sexual Minority" youth is a term used in the report to describe LGBTQ youth.  Some may quibble with this term but the spirit of the report is an admirable one.  Sexual minority youth may be at higher risk for early sexual activity, multiple partners, and unprotected sexual encounters and therefore higher risk for STI's.  The report also points out that "Many adolescents who self-report as lesbian or gay may have sex with members of the opposite sex, and thus behaviors do not equal identity" Recognizing this is important for practitioners since they should not assume that a lesbian teen is free from the risk of pregnancy.  Providers need to ask questions using gender neutral language (e.g. "Tell me about your partner?")and do a complete assessment.

Caring for youth means really caring and when providers stop to evaluate their own biases and knowledge and the lacunae that sometimes make them appear insensitive, they will be able to engage their patients in a refreshing and interesting way that not only spices up everyday routines in practice but will endear them to some of their most needy and interesting patients.

image from allunderoneroof.org via Google images