Narrative Matters: On Our Reading List

Editor's note: "Narrative Matters: On Our Reading List" is a monthly roundup where we share some of the most compelling health care narratives driving the news and conversation in recent weeks.

Doctors On The Clock

The standard 15-minute time limit imposed on most doctor visits is so much maligned that one wonders why more physicians haven't revolted. In an essay for The Washington Post, physician Michael Stein explains his silent struggle against the clock, using the example of an encounter with a patient whose back pain could be exercise-induced or perhaps stress-related. Stein wonders whether he should ask his patient additional questions about the stressors in his life, knowing the answers might lead to a more accurate diagnosis but will certainly cause the appointment to bleed into his next.

The status quo is seriously flawed, Stein explains, but the alternative—spending time on paperwork to justify longer appointments to insurers, or seeing fewer patients in a day—isn't desirable either. "A hurried, task-oriented approach doesn't accommodate the meandering, overlapping, widening issues of patients," he writes. "It undermines kindness. And it prevents doctors from being what our patients hope we will be when they walk in: unrushed explorers on the lookout for the next discovery."

A Mother's Anguish

In a difficult-to-read post for The New York Times' Motherlode blog, Amber Scorah tells a story that would be any new parent's nightmare. After three months of paid maternity leave, Scorah left her son Karl at a day care in New York for the first time. When she returned during her lunch break to nurse him, she found the day-care staff performing CPR incorrectly on her unconscious child in an effort to revive him. He was not revived.

Scorah says her piece is not about day-care safety (though it raises many important questions about licensure and health care training among staff at child care facilities) or an indictment of the company she works for, but rather an essay about the impossible choices that parents must face in a working culture that "places very little value on caring for infants and small children."

She writes: "Parental leave reduces infant death, gives us healthier, more well-adjusted adults, and helps women stay in the workforce. If we truly valued the 47 percent of the work force who are women, and the value of our families, things would look different." Scorah acknowledges that she will never know if things would have gone differently if Karl had been home with her that day. "But had he had been with me, where I wanted him," she writes, "I wouldn't be sitting here, living with the nearly incapacitating anguish of a question that has no answer."

Women In Orthopedic Surgery

In "My Summer in Orthopedic Surgery," an anonymous essay published on in-Training, an online magazine for medical students, a student describes the realities of being a woman poised to enter the male-dominated specialty of orthopedic surgery.

During a summer spent doing orthopedic surgery research, the author found that several stereotypes of orthopedic surgery—the fraternity-like culture, crass jokes, and flirtatious behavior on the part of her male colleagues—proved true. Making orthopedic surgery appealing to female physicians is important from the standpoint of attracting the top applicants to the field, and of sensitizing surgeons-in-training to people of various backgrounds, the medical student writes. Fortunately, she came out of her summer experience more determined to enter the field and to "play a small role in changing the idea of what type of person becomes an orthopedic surgeon."

Caring For Patients At Home

In a photo essay for NPR, "Doctor Treats Homebound Patients, Often Unseen Even By Neighbors," photographer Misha Friedman offers a view into the working life of a home care physician named Roberta Miller, who has been visiting patients at their homes in upstate New York for more than 20 years.

"Sometimes it's overwhelming," Miller tells Friedman. "You have to set limits, and when you do that, you can have a really excellent working relationship with people." Home visits could be the future of medicine, Friedman writes, noting that the trend is expected to accelerate as baby boomers grow older. Yet, there aren't enough home care doctors to go around currently, largely due to poor reimbursement, and home care skills are rarely taught in today's medical education system, Friedman points out. As his text and photographs show, house calls are demanding and at times draining — but make an entirely different type of care possible.

Teen Suicides

Hanna Rosin reports on clusters of teen suicides (in 2009 and 2014) at two high schools in Palo Alto, California, in The Atlantic's December cover story, "The Silicon Valley Suicides." Beyond the story of local grief, her deep dive tells the broader story of affluent youth as a largely unrecognized group at-risk for unsafe behaviors, alcohol and drug abuse, serious anxiety, and depression. Rosin juxtaposes the high stress and pressure facing young students against the sleek backdrop of wealth and power in Silicon Valley and similar areas, discussing the role of parenting, the school system, social networks, and other factors in these suicides.

It's an important story to tell: adolescent suicide has dropped dramatically since the 1990s, but in the past few years has started to creep back up, Rosin notes. Yet she acknowledges that even as she better understood academic stress and adolescent misery through her reporting, the ultimate question of why teens kill themselves was never answered.

"Admitting we don't entirely know why teenagers kill themselves isn't an invitation to do nothing to prevent it from happening," she writes. "It's just a call for humility, a short pause to acknowledge that a sense of absolute certainty about what children should do or be or how they should operate is part of what landed us here."

In Case You Missed It

In December's Narrative Matters essay, physician Cheryl Bettigole reflects on the bitter reality of delayed and denied care that her immigrant patient faced more than a decade ago and that many immigrants still face today. The essay was also excerpted recently in The Washington Post.

from Health Affairs Blog http://ift.tt/1YReP93