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Saturday, May 04, 2013

 
6:42 PM: fluoride fight [#] [1]

i find myself in the surprising position of voting against fluoridation. as a child from a fluoridated small town, i was shocked when i moved to portland to find the water wasn't fluoridated.

i appreciate that portland was willing to vote on this issue, but a lot of hysteria around fluoridation kept me from engaging with it for a long time. the essence of the the anti-fluoride argument seemed to be "CHEMICALS BAD!" while the essence of the pro-flouride case seemed to be "IF YOU VOTE AGAINST THIS YOU HATE POOR CHILDREN."

but ultimately i've come to decide that fluoridating portland's water will not provide enough good to justify medicating the water supply. my top 3 reasons are ones i haven't seen discussed a lot elsewhere and had to come to on my own:

1. i have a strong personal ethic to support autonomy and consent whenever possible. this is especially true when it comes to medical treatment. when municipal water is modified, nobody can opt out. in that situation, the only way to control an individual dose of fluoride is to buy bottled water. plus, not everyone affected by this change can vote on it, creating a system of fluoridation w/o representation. portland is voting on this because the portland city council has the authority to make this change, but fluoridation will affect three counties and several cities who won't have a choice in the matter. i think vaccinations and schools have a higher compulsory value than fluoride, and both of those legally allow for exemptions.

2. fluoride is only effective topically. it was once thought to be systemic, hence the creation of fluoridated water systems. so... why go through the hassle and expense and non-consent if there are other, more effective topical treatments? for instance, the oregon department of human services recommends four things to enhance the dental health in all of oregon, only one of which is community water fluoridation. the others are early-childhood cavities prevention programs, school-based fluoride supplement programs, and school-based dental sealant programs. i would prefer to start with the least invasive methods first to see what impact they have before taking more drastic measures like fluoridation.
[http://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/smile_2007.pdf]

3. but wait! here's the amazing part: according to the same report by the oregon department of human services (the most recent SMILE survey available), dental health in metro pdx is vastly better than the rest of oregon, and even better than the national average! 21% of portland 3rd graders have untreated decay, compared to 29% of the national average and 44% of the rest of oregon. so it looks to me like the area already served by our unfluoridated water doesn't even need to be remediated! in addition, the cdc promotes a maximum of 60% reduction in dental decay when fluoridated water is added to the water supply. which sounds big until you do the math: in the best case scenario, we'd only be moving from a rate of 21% to a rate of 13%, an absolute change of less than 10%.
[http://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/smile_2007.pdf]
[http://www.cdc.gov/fluoridation/pdf/natures_way.pdf]
ETA may06: from a draft of the 2012 SMILE survey: "...the oral health of 6 to 9 year old children in Oregon has improved" primarily due to school intervention programs rather than fluoridation.
[http://images.bimedia.net/documents/SMILE+Survey+2012+Draft+Results_4-23-13%5B1%5D.pdf]

so for me, i would want to see overwhelming benefit to justify overriding personal autonomy and consent. based on my research, i feel the pro-fluouride side uses the statewide numbers to justify the city vote, and that makes me feel manipulated and resentful. but i am still open to other thoughts because this is such an unexpected position for me.

Friday, April 05, 2013

 
10:10 PM: albany bike trip [#] [0]

i took a working vacation in Albany during a 4-day SP event instead of driving home every day. it's about 12 miles from Albany to Lebanon, which is just about an ideal commute in the country.

My favorite road name: Lickskillet!

I pass this sign every time I work down there and I love it because this honey sign is actually on Honey Sign Drive:

A lot less fond of this sign, however:

Timber Linn Lake at nightfall. This is a gem of a park:

So I had a wonderful time until, on the last day, i crashed on the train tracks and scraped myself up pretty bad. a few days later i fell down the stairs and twisted my ankle. i didn't get on a bike again for weeks.

also, a strange encounter: a guy in a truck saw me biking down the road, turned his truck around, and followed me. he rolled down his window, asked if i was okay because he was very concerned for me out here and told me how beautiful i was. creepy!

Tuesday, March 05, 2013

 
3:35 PM: notes from a professonal patient [#] [0]

(note: long post primarily intended as a material archive)

I went to the SE Artwalk this weekend. I visited Amelia's studio, who let me babysit Miles to earn some extra money when I first moved to Portland. (Miles is now 13 OMG!). She asked what I was up to and I realized I've never really written about my work as a Standardized Patient, someone who acts in scenarios with medical students. I work with several different schools between Lebanon, OR and Vancouver, WA. Scenarios can include anything between a simple interview, a basic physical exam, or a full-on simulation w/ costumes, props & furniture, etc. It is SO much fun and I feel so lucky I have found the perfect spot combining education, acting and medicine.

When Amelia heard me talk about my work her first question was "Are you blogging this?!" I do post comments about my job on Twitter frequently, so here's a selected collection of my tweets with the #sp tag over the last 4 years. I imagine I'll update it as other interesting stuff occurs rather than creating a whole new post about it here.

all in a week's work: unplanned pregnancy, affair, angry street confrontation, stiff back, crisis homebirth, depression, rejected premed #sp

student compared abortion clinics to car dealerships: "well if you go to a Toyota dealer, they'll try to sell you a Toyota." #sp

"is there something good for you waiting at the end of this?" #sp #depression #bawl

If you touch me, the game is over. #sp #selfdefense

I like to use the whole scale, unless I'm punished for using the whole scale. #sp

nobody died tonight! #sp

reviewing "hail Mary" prayer for #sp case tonight.

you want me to play a character that asks a lot of questions? perfect! #sp

who am i this week? a hairdresser, a street person, a financial analyst, and a woman watching her husband die in the ICU. #sp

watching angry subway/street rant videos is pretty depressing. but i finally have a use for the guy who harassed me on the max last yr. #sp

student upset because my #sp character had an unexpectedly "male" name. "they'll be hearing from me about THAT!" he declared.

my comfiest #sp costume: big fluffy robe, tank top, sweatpants, handknit socks.

hey! i made my financial goal this month! #sp #march

f/u doesn't mean what you think it does. #sp

i sure do love acute cases. "i'm in a lot of pain and i have no idea why" means very little to memorize. #sp

next week is a big #sp week: 10 different cases & a training in lebanon. biggest stretch: 86 yo w/ congestive heart failure.

just ordered a stethoscope to do double duty as a play prop and #sp item. the best part: i can claim it on my taxes.

"you will no longer be subjected to safety pins." OH THANK GOD. #sp

just realized i'm two weeks out from the hardest event of the year and i don't have the scripts yet. #gulp #sp

made much more small talk than expected during depression mmi. "oh, you're fine? ok! what else can we talk about, then?" #sp

Today's case: Partying Pat! I love that I can pretend to have been at the @amandapalmer purple rain concert as part of my job. #sp

so it turns out being tired contributes quite nicely to Angry ER Patient. #sp

seriously, if you ever find yourself in a conversation saying something like, "don't feel that way," stop. #sp

that was a long day with a lot of concussions. #sp

Oreos: not the best snack food when a student is going to look in your mouth. #sp

today: insurance claims investigator w/ kidney infection. #sp

last of the resident HIV misdiagnosis cases till next fall. #sp

pro tip: don't tell a depressed person "nobody wanted to talk to you because they were probably afraid you would react like this." #sp

tomorrow's checklist has 60 items on it! #sp

@pdxmph "i guess that doesn't explain the coughing, but it would explain all the other symptoms." #sp

@pdxmph yes. and i had to use all my willpower to keep from laughing when he asked that. because he was serious. #sp

possible (wildly incorrect) diagnosis: "could you be pregnant?" um. not with pneumonia, dude. #sp

every school is different. every school is different. every school is different. #sp

good feedback with a student who had been told multiple times what was wrong, but not how to make it right. he left feeling relieved. #sp

i get to work w/ @Sven today! #sp

the scenario will end when they’ve "killed you, transported, concluded the post-hemorrhage education or they’re out of ideas." #sp

have you ever had to define the difference between empathy and rapport? i have. #sp

but I wanted abnormal mammogram results! #sp

it's nice to have a job where I have to pretend I feel bad when I really do. #sp

tomorrow morning i will be a jazz pianist. in the evening, i'll have just given birth. #sp #pendulum

so my hand mnemonic is coming along. #sp

tomorrow's #sp cases: knee, pneumonia, and Zombie Patient 0.

when i do smoking cessation cases, i fantasize about buying nicotine patches, even though i've never smoked. #sp

I'm timekeeper today; I guess that means I didn't ruin it last time after all. #sp

sometimes "i'm sorry to hear that" sounds like "i'm sorry you told me that." #sp

had a student tell me about blowing out his eardrum: "woke up with blood on my pillow!" gaaahhhh! #sp

gah. scheduling snafus. i wish events lined up in neater blocks instead of overlapping. #sp

if we want doctors who aren't afraid to admit mistakes, then #sp educators must model good behavior.

I love that I have a job where I have to ask myself: "How do people communicate sincerity, anyway?" #sp

ha ha ha! another high stakes case I haven't been trained for! let's DO IT! #sp

sometimes they pay me to recreate scenes on a felt board. it's way more interesting than it sounds. #sp

a whole week with no #sp jobs or obligations? this calls for adventure! just booked a bus to to the coast tomorrow.

WHY do I keep forgetting to give students the clue card? #sp #embarassing

pretty sure i'm not up for being an eye model: 8 weeks of eye dilation & an hour per exam. #sp

hmm. ncnm has invited me to return as an academic model. (good euphemism, btw.) #sp

monday i was a hockey player. tomorrow i will be misdiagnosed with HIV. #sp

amputation today! yay! #sp

and yes, I am a little fussy about ungowning instructions. clear instructions will save us both a lot of embarrassment. #sp

if I'm coming in for low back pain, why wouldn't you want to even look at my back? GRAAAAARRRR! #sp

it amazes me how few students are checking the area of primary complaint on this case. seriously! #sp

@TeenaKP i was an elementary school teacher in my #sp case today and tried to channel you. :)

you're still sending revisions to a case we're doing tomorrow? gaaaaah! #sp

today i'm a flight controller! #sp

my #sp scenario video was shown to the group as a good example, but like all i could notice was like how many times i like say "like."

today someone apologized for scheduling me so much because I was so "versatile" and fit so many cases. please don't apologize for that! #sp

"we usually take 3 hours to do this training." WELL WHY ARE YOU DOING IT IN 2, THEN? GRRAAAARR! #sp #intothefire

counseling an HIV medical error case in 12 minutes? WOW. this will be interesting. #sp

it's gross when a fellow #sp admits he likes "pretty young things feeling up my chest" and ends with "works for me, honey!" #grrrr #yuck

i'm having headaches again. i probably have 5-7 different headache cases a year. #sp

how can my low back pain both hurt constantly AND off/on? as if cases aren't hard enough to memorize. #sp

@AnStou the medical assumptions built into picking job occupations for cases is fascinating. #sp

@AnStou and i'm a divorce lawyer! probably not a lot of happy stone piles in my life. #sp

@AnStou tomorrow i will have diffuse bilateral lumbar pain with occasional radiation from left lateral thigh to left medial knee. whee! #sp

we're in an awkward #sp scheduling phase: lots of schools asking about availability, but no commitments yet. my calendar trembles.

using my #sp job in lebanon as an excuse for riding a bike in the willamette valley is pretty awesome.

#sp work is ramping up again. thursday i have a case in which i am a bartender who does not drink. what?

@TeenaKP #sp feedback: "leaving a patient unnecessarily vulnerable affects their confidence and trust in you."

met an #sp student on the safari to estacada ride. "you look familiar..." she said.

a student hit my knee so hard with a reflex hammer today i had to time out, rock around a bit in pain, and tell him to stop. #sp

tried not to wince when one of the students said, "oh! i've heard about you! you're tricky!" #sp

bad training begins "so this looks like a pretty easy case. you guys have any questions?" #sp

gah. i need to teach myself a good way to remember the difference between prone & supine. #sp

when everyone sets their timers at once, it sounds like a symphony. #sp

"can we stay and watch you change?" totally inappropriate, fellow #sp. :(

a new opportunity? "I have unique insight into ... communication skills that are often invisible in customer interactions." #sp

I am no longer a severely anxious medical student: neck, you can relax now. Please relax, neck. Please. #sp

still buzzing from ace feedback i gave a student today. #sp

eye makeup? argh. #sp

pantyhose. argh. #sp

practicing not moving the right side of my face #sp

#sp student during depression case: "your husband wasn't able to be there for you in the same way you would have been there for him." *bawl*

if you tell me when i stopped smoking, maybe you should tell me when i started. #sp

pleeeeasse don't ask me to be a med student as an #SP. it just makes the students ask me questions i don't know the answers to.

one of my students today said i had "nice tonsils." #sp

I know I'm doing feedback right when students want to keep talking to me after the event is over. #sp

resistance is fear. find the fear, face the fear. #sp #medicaladvice

also, that last case is one of my biggest fears as I age: progressively worse knee problems over 20 years till pain reaches 8/10. #sp

having knee/ankle injuries is making my job at the chiropractic college more difficult. I say, "that's me, not the patient" a lot. #sp

busy week coming up: 9 sessions, 9 different patients. #sp

sometimes I have a day where all students are pretty good -- and then one that runs us off the tracks. #sp

surprised to discover my personal doctor has observed at some of the #sp events at compnw. small world!

oh, right. THIS case. the timeline is... complicated. #sp

my assumptions about this #sp character involve a lot of makeup.

made it to centralia! late lunch while waiting for room. then I'll call my #sp client!

created timer announcements for my independent #sp sessions.

managed to book myself a job while traveling. i also managed to set myself up with 3 back-to-back cases to memorize by thursday. #sp

sometimes I think my standards are too high. and then a student simply nails it and I wonder why I ever doubted myself. #sp

well, geez, if you meant TB test, why didn't you just say that? i've been chasing this acronymn down for 20mins. #sp

when i am a depressed #sp: 1/8 students makes me feel relieved, 6/8 try to "fix" me, 1/8 makes me feel much much worse.

I eavesdropped on someone's feedback session through the wall. I wish I could do that more often. #sp

that was a really great day for feedback. #sp

bike pain case tomorrow morning! yay! (also, unrelated sexual history case in afternoon. :) #sp

you want my opinion about #sp work? excellent!

#sp scenario w/ @Sven, jalex & me! small strange wonderful world.

head still draining: partying cousin, rejected medical student, depressed grade school friend all in one day. #sp

both my baby & i survived tonight's scenario! that's a first. #sp

makes me wish siri could control voice memos, so i could rehearse while riding bike to work. #sp

bloody genius: i recorded myself asking questions about my cases in voice memo. now i playback and quiz myself! #sp

some schools value #sp feedback, whereas some schools treats SPs like animatronics.

next week i'll be 11 different people. these are the only exams i write notes for. #sp

if i am depressed, telling me i am "unkempt" is unlikely to help. i almost burst out laughing, so i had to act offended instead. #sp

I love having a job where I can read hyperbole and a half to get into character. 

pleeeeeease don't make me get up at 5a if i don't have to! #sp #snowday

seems easy: phone cases are less memorization. but i have to hit 3 very different emotional tones in 3 different phone calls. whew! #sp

having my bike stolen helped me play "angry ER patient" with particular verisimilitude today. #sp

it's nice to come back from an audition with an email already waiting: "we hope you are interested in taking the next step." yes! #sp

quick bruise recipe: red base, blue & purple dabbed in center, yellow & green on outer edges. apply to cheek or wristbones. #sp

#sp casebook: female w/ fatigue: domestic violence. male w/ fatigue: car crash/failed rescue. hmmmm.

feedback today: "you're adorable. but adorable isn't a quality i'm looking for in a doctor." #sp

does your job include electrodes? if not you're totally missing out. #sp

heh: "which readings/textbooks did you find MOST useful?" "Gretchin!" #sp

why do you ask me for more time? you know I cannot give you more time. #sp

first year students take such different blood pressure readings! #sp

why do you call me a "volunteer" if you pay me? #sp

it's apparently my natural instinct to take a solitary event and try to systematize it. :) #sp

finally! a "party girl" case! my boss once told she couldn't see me in those because i was "too pure." #sp

q: did anything happen 3mos ago? obvious answer: "i moved from seattle to portland." correct answer: "nothing i can think of." what? #sp

i saw these same students last week in a very different context. i had to work extra hard to stay in character based on their reactions. #sp

if you can't pronounce "allergies," then i can't recommend you become a doctor. seriously. it's a life-threatening issue. #sp

working w/ ohsu admissions today, evaluating candidates via scenarios. ee! #sp

best quote from a frustrated student: “making a patient uncomfortable makes me nauseous.” #sp

sometimes I feel like Troy McClure: "you may remember me from such cases as Cranial Nerve Exam!" #sp

feedback I never thought I'd have to give again: "never joke about beating a woman with a hammer, even if it's just a reflex hammer." #sp

ha ha! i love this case! "You are retired but very active on the senior citizen social scene..." #sp

I love it when I figure out a new piece of feedback to give students. #sp

headed to an ultrasound anatomy class. #sp

THIS is what i do! #sp http://www.oregonlive.com/health/index.ssf/2011/08/oregon_health_science_medical.html

have to learn hymns for this character! #sp

working at the chiropractic college always makes me hyper aware of my posture. #sp

told a student never to joke about beating/bruising women during a doctor visit. #sp

have you ever needed to count backwards from 100 by sevens? it's tougher than you think. #sp #lifeskill

i love acute pain cases. tip: don't talk over a patient who is clearly exhibiting signs of short, intense pain. #sp

today's #sp smokes medical marijuana.

as an #sp, the latest xkcd really cracked me up. my students would freak if i did this to them. :) http://xkcd.com/883/

View on Twitter

first time in a scenario where I almost died! AND I lost my baby. :( #sp

off to give birth! #sp

did a #bike case today! numbness & tingling in pinky & ring finger due to a new bike. #sp

@pdxmph ha ha ha ha! :D alas, no. but i get called "heather" and "rachel" a lot, so i use them as #sp names.

i finally have a use for all the mistaken names people have given me over the years! #sp

haaaaate the sharp/dull tests at uws. they use actual safety pins, rather than a toothpick. #sp

reviewing women's weightlifting sites for an #sp case tomorrow.

reading birth stories from "spiritual midwifery" to prep for #sp case next week.

even if just playacting, 8/10 pain for 45 minutes is still hard. #sp

i feel like i'm cramming for finals #sp

ready? i'm going to be 13 different people this week. #sp

hates it when the case specifies i haven't taken any medications. 10/10 pain and no advil? REALLY? #sp

starting to lose track: who am i tomorrow? today i said i had rheumatoid fever as a kid, which is a character for another school. #sp

tomorrow i will be 14. how's that for a wide range of acting ability? #sp

Saturday, March 02, 2013

 
8:25 PM: butler creek greenway [#] [0]

well this was a pleasant trip. i found the perfect picnic spot near a bubbling creek.

Wednesday, February 27, 2013

 
9:38 PM: veggies first! [#] [0]

creating cute veggie snack boxes makes it much more likely i will eat my 5 servings of vegetables & fruit in a day:

sven likes them, too:

also works for cheese & other savory snacks:

Thursday, February 07, 2013

 
2:26 PM: seattle amtrak brompton trip [#] [0]

the first trip for the brompton was a trip to seattle! amtrak had a half-price sale which justified taking the train to explore seattle and meet friends for a couple of days. the brompton performed admirably.

relatedly: i really need to figure out a better system for "scanning" sketchnotes.

Sunday, January 27, 2013

 
4:04 PM: marching on [#] [0]

so: march! i was really happy with the work i did for this show. i haven't directed in over 10 years, but i felt prepared and polished. about 70 people came, which is more than i had hoped.

for a staged reading it had fairly involved blocking and characterization. it was a delightfully complex script that required three very long meetings w/ the playwright and two different timelines. my current work with the medical community & former work inside academia gives me some unique perspectives into the script. most of the actors were wonderfully responsive and a delight to watch. i was especially pleased with a decision i made to make the person who reads stage directions more of a narrator than a bland background voice: i asked her to add poetry and characterization and commentary to the lines.

one of the most interesting discoveries for me during this process was that i am a different director than i was in college. i used to approach directing as a way to move actors on the stage and get them to say things the way i thought they should be said. but now my primary goal is to communicate the story to the audience, rather than reproducing what i see in my head. that gives actors more flexibility and ownership. my job is to step in when things are unclear or to adjust pacing and other details to communicate more clearly. i prepare a LOT beforehand to get clear in my own head, but i prefer to ask questions to lead actors to their own insights rather than instructing them. i think that change is almost certainly due to my work with Backline and my evolution as an SP. it feels like a very respectful, valuable way to work. (and i brought snacks: hungry actors are unhappy actors!)

there's always more i could have done, of course. for instance, i would have loved some more rehearsals! also, we didn't tape it. the script includes some shadow play w/ projectors and some projector visualizations i think would have been great, but i couldn't manage to include it in the amount of time i had. i made some excellent preshow music, mixing selections from on "einstein on the beach" to express the pattern of March's life pre and post stroke. i loved the way it combines counting and singing. that turned out to be a colossal waste of time because by the time the doors opened, there were already so many people and the atmosphere was buzzing so much that it was impossible to hear. lesson learned. :)

rehearsal:

performance: