Great Scores Don’t Necessarily Mean Great Doctors

Written by yvonnethornton on April 16th, 2012

If you’re planning to go into the medical field like I did, then you’re probably aware of the strict application process most medical schools will put you through.  If you don’t have the right grades or MCAT scores, you might not get into the school of your choice, no matter how badly you want to help people.  Unfortunately, this means top medical schools are letting in bright students who are great test takers, but who can’t take care of patients.

Being a physician is about much more than memorizing information from medical encyclopedias and science classes.  I’ve found that a strong sense of empathy and compassion for others, as well as a generosity of spirit has been crucial to my success in medicine.  It allows me to put myself in my patients’ shoes, which in turn gives me a better sense of what to ask and what to look for.

Many aspiring doctors don’t have the grades to get them into the top schools, but they may have more emotional intelligence than the students who beat them out for those spots.  Eventually, the positions of physicians are filled with very smart people who just don’t seem to take the time or care patients need.  It takes patience to listen to everything a patient has to say and then to dig even deeper.  It’s not about solving a puzzle as fast as possible.  It’s about understanding underlying issues that may not be obvious at first glance and knowing how to uncover them tactfully. It all goes back to bedside manner, which seems to have disappeared in an absurd dichotomy of doctors having the attitude “I know it all and you know nothing”. Doctors must listen to patients. Our patients know their bodies better than their doctors do. After all, patients live in their bodies. We only visit those bodies.

Luckily, after three years of study, the American Medical Association has realized this and is encouraging medical schools to look deeper into their potential students than just their test scores.  As a result, many are adding comprehensive interviews that attempt to find out who the applicant is as a person, not just as a student.  The Association of American Medical Colleges has also announced that it will be changing the scope of the MCAT exam to include more emphasis on psychology, sociology, and biology.  President of the AAMC, Darrell Kirch, said about the changes, “Being a good doctor is about more than scientific knowledge.  It also requires an understanding of people.”  I couldn’t agree more, and I hope this changing philosophy will help bring patients more compassionate and effective doctors.

— Yvonne S. Thornton, M. D., M. P. H.

 

Posted in General health news, Health care policy, Women's health news | No Responses »
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Uterine Artery Embolization for Fibroids (Myoma)

Written by yvonnethornton on April 6th, 2012

I have been asked many times the best approach to the treatment of myoma (the correct term for the common term “fibroid”. There are many approaches, most include surgery, i.e., hysterectomy or myomectomy. Recently, a less invasive management has been offered and should be considered prior to surgery. It is Uterine Artery Embolization.

Uterine Artery Embolization (UAE) as another alternative treatment for fibroids (myoma): This latest less radical approach to reducing myoma (fibroids) was first tried in France and has been available in the United States for over a decade.

The procedure entails inserting a catheter (long hollow tube) in the major arteries of the thigh (femoral artery) and threading the catheter to the area of the fibroids. Using an inert material (polyvinyl alcohol) in the form of beads or particles, this material essentially cuts off the blood supply to the growing myoma (fibroid) resulting in shrinkage of the fibroid. Interventional radiologists have promoted this procedure as opposed to gynecologists who have proceeded with much more caution. The known side-effects have been serious systemic infection, excessive bleeding from the catheter insertion site, chronic pelvic pain after the procedure and, in some patients, early onset of menopause. Uterine artery embolization has been associated with decreased fertility.

In August, 2010, the conclusion of a 5-year outcome study from the embolization versus hysterectomy randomized clinical trial (EMMY) was that UAE is a well-established alternative to hysterectomy about which patients should be counseled.

So, if you are a candidate for myomectomy or hysterectomy because of myoma, perhaps a discussion about UAE would be helpful.

——Yvonne S. Thornton, MD, MPH

 

Posted in Women's health issues | No Responses »
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In came Beyoncé and the security guards. Out went the hospital’s common sense—and common decency.

Written by yvonnethornton on January 13th, 2012

As an OB-GYN who has delivered thousands of babies—including several with rich and famous parents—I’m scratching my head over the insanity at Lenox Hill Hospital in New York City surrounding the birth of Beyoncé’s baby.

Here’s a sampling of what went on, according to The New York Times:

The familiar area outside the neonatal unit had been transformed: partitions had been put up, the maternity ward windows were completely covered, and even the hospitals’ security cameras had been taped over with paper. Guards with Secret Service-style earpieces roamed the floor.

“We were told we could walk no further,” Ms. Nash-Coulon said Monday. And when she and her husband, Neil, demanded an explanation, she added, the guard claimed, unconvincingly, “ ‘Well, they’re handling hazardous materials,’ ” even as a large group of people screened from view were passing through the main hallway he had declared off-limits.

Let me make this perfectly clear: The hospital had no right to bar other patients from having free access to their babies.  Worse, from a safety perspective, doctors were prevented from visiting their own patients on rounds, because of this so-called “security.”

Someone in the hospital decided that the celebrity of a hip-hop artist was sufficient to ignore medical necessity and common decency. Not a good message to send to sick people.

Beyond that, I’m alarmed to learn that the baby was born by Cesarean, as so many celebrity babies are today. I could be mistaken, but I doubt that Beyoncé’s OB-GYN warned her of the risks before treating little Blue Ivy’s birth like just another item on the to-do list. The risks are real: a dramatic increase in maternal deaths due to hemorrhage and infection; more babies ending up in the neonatal intensive care units after Cesarean births because of respiratory distress.

If she’d been my patient, I’d have told her what I tell other mothers-to-be: if God wanted women to have Cesareans, he would have put a zipper in the pubic area.

– Yvonne S. Thornton, MD, MPH

 

Posted in Childbirth & delivery, General health news, Women's health issues | 1 Response »
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Kids—follow your dreams, whatever they may be. And Mr. Gingrich, clean your own damned toilets

Written by yvonnethornton on December 16th, 2011

I don’t usually discuss politics on my blog (although, in today’s world, even something as essential to life as paying for medical care has become political). So, I hesitated to speak out when one of the men vying for the GOP nomination for president said something so wrongheaded and racist that it made me ill.

But, on reflection, I realized that this isn’t about politics simply because the person making the comments is a politician. It’s about dignity. It’s about respect for other human beings. And it’s about the truth.

Here are some of the comments made by former Speaker of the House, Newt Gingrich:

http://www.youtube.com/watch?v=GTKr3SRWslM&feature

 

“Really poor children in really poor neighborhoods have no habit of working and have nobody around them that works… They have no habit of showing up on Monday. They have no habit of staying all day. They have no habit of, ‘I do this and you give me cash.’ Unless it’s illegal.”

 

Mr. Gingrich’s answer to his made-up “facts”? Get rid of child labor laws. Get rid of unionized janitors. Instead of teaching children in schools, put poor children to work as the schools’ janitors, cleaning the toilets.

Let me speak as the daughter of a ditchdigger and a domestic. They were poor, but that didn’t mean they didn’t work. My daddy worked two jobs — 16 hours a day — and took side jobs on the weekends. My mother cleaned other people’s houses because a lack of money for tuition forced her to drop out of teacher’s college in her senior year. Together, they probably worked more hours in their lives than people like Mr. Gingrich would or could survive. And they didn’t do it so that my sisters and I could be janitors, but so that we could become doctors. And you know what? Three of us did become doctors, and one became a lawyer.

That’s what my two memoirs are all about. The Ditchdigger’s Daughters tells the story of hard-working impoverished parents with a dream for their daughters to do better. Something to Prove  is the story of how I passed down that dream and work ethic down to my own children. Woody, my son, a neurosurgical resident and a cum laude Harvard graduate, is the grandson of a ditchdigger.

There were plenty of racists around when my sisters and I were growing up. They wrote us off and expected us poor little black girls never to leave the housing projects. But our parents convinced us to dream the big dreams.

Maybe I should send Mr. Gingrich copies of my books. Maybe it would open his eyes. Because if Mr. Gingrich had his way, my son would be cleaning toilets like his grandmother, and digging ditches like his grandfather. I’m not saying that hard, manual labor is something to be ashamed of, but we can do better.

Sadly, it becomes more difficult for young people when racists in high places can’t see our children aspiring to anything more than a plunger, a shovel, or a broom.

I’ll close with an excerpt from the blog of another formerly poor black child, Travon Free, whose hardworking parents made sure he had the tools to make a success of himself, and who has a few choice words in rebuttal to Mr. Gingrich’s:

 

 “As a child who grew up in Compton in the early 90s, one of the most dangerous neighborhoods in America at that time, I watched my mother work tirelessly, sometimes juggling multiple jobs to provide for myself and my sister. Day in and day out, like many other parents in poor neighborhoods, she did what she had to do in order to provide for us.

You know what that turned into Mr. Gingrich? “A son who received academic and athletic scholarship offers from three Ivy League schools and countless other universities, a son with a college degree in Criminal Justice who graduated with honors from every school he attended, and a daughter who not only attended a Gifted and Talented Education high school, but is one year away from completing a degree at UCLA.”

 

Bravo to Travon Free. And to all those who haven’t yet escaped poverty, keep working. Keep believing in yourself. Don’t let people who know nothing about you discourage you, or pull you down. Pick yourself up and set yourself on the path to realizing your dreams, no matter how impossible others might say those dreams are. If I could do it, you can do it.

– Yvonne S. Thornton, MD, MPH

 

Posted in Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters | 4 Responses »
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Gone almost 30 years… always in my thoughts

Written by yvonnethornton on December 5th, 2011

Maybe it’s the holiday season that just naturally brings back memories of those we love. Or maybe it’s because my father, Donald Thornton, is never far from my mind. But even something as seemingly innocuous as doing some upgrades in our home stirred vivid memories of Daddy, who readers will remember from my memoirs, The Ditchdigger’s Daughters, and Something to Prove.

My husband Shearwood and I were talking to our security firm about improving our home security system. And it brought me back to the day that my father and mother accompanied me to Bard Hall, where I was to room, when I first entered Columbia University College of Physicians and Surgeons in New York City.

I would be living away from home for the first time, and in big, bad New York City, no less. My parents had already helped me settle in and, reluctantly left me in my new room. I assumed they were on their way home. Then Daddy came back to the room, carrying a heavy glass ashtray. After giving me yet another talk about how important it was for a young woman to be careful and vigilant, he handed me the ashtray, which was odd, because I didn’t smoke.

The ashtray was for security purposes, he said. He instructed me to place it above my door, so if any one tried to come in, it would fall and alert me and I could defend myself—or just run.

I thanked him, and promised I’d be careful, but I never did use his makeshift security system. I knew perfectly well that the first time I rushed out the door, I’d be the one to get bonked on the head.

But, just knowing that my Daddy would always look out for me (and yes, I believe he still does, though he’s been gone since 1983), made me feel safer.

And I still have that ashtray.

– Yvonne S. Thornton, MD, MPH

 

Posted in Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters | No Responses »
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Baby’s tastebuds mirror Mom’s food choices?

Written by yvonnethornton on November 30th, 2011

You’ve probably heard the claim that exposing a baby in the womb to Mozart will increase his or her IQ. Despite the hype, the research doesn’t support major leaps in smarts (but, if nothing else, it might improve your child’s musical taste, later on).

Now, there’s some evidence showing that you may be able to shape a yet-to-be-born child’s taste in food.

“The flavor and odors of what mothers eat show up in the amniotic fluid, which is swallowed by the fetus, and in breast milk. There is evidence that fetal taste buds are mature in utero by 13 to 15 weeks, with taste receptor cells appearing at 16 weeks, according to researchers.

“’With flavor learning, you can train a baby’s palate with repetitive exposure,” said Kim Trout, director of the nurse midwifery/women’s health nurse practitioner program at Georgetown University.

“Trout recently co-authored a paper that reviews the evidence on prenatal flavor learning and its implications for controlling childhood obesity and diabetes, among the country’s most pressing health problems…”

 

Although I’m just as skeptical of this claim as I am about the one for baby-and-Mozart, I see real benefit in giving this a try, whether it makes your baby want broccoli or not. That’s because, in my practice, I see too many women gaining too much weight during pregnancy, which can not only cause complications for mother and baby, but can be almost impossible to shed once your baby is born.

So, bring on the Brussels sprouts, and eschew the Twinkies. Pass by the apple pie and bite into a nice juicy apple instead. Whether it does a thing to change your baby’s mind about what tastes good later in life, it will do a world of good for you both right now.

– Yvonne S. Thornton, MD, MPH

 

Posted in General health news, Pregnancy, Women's health issues, Women's health news, Your newborn baby | No Responses »
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My memoir’s getting lots of media attention: good news and bad news

Written by yvonnethornton on November 22nd, 2011

Yes, that’s me on the cover Living, the Jersey Shore magazine, and there’s a lovely, long, detailed article inside, that talks in-depth about my latest memoir, Something to Prove, as well as my first memoir, The Ditchdigger’s Daughters.

I’m thrilled to have gotten the coverage, especially now, when I learned, in a roundabout way, that the publisher of Something to Prove is getting out of the trade (consumer) book business.

Erik Sherman of CBS News wrote all about that, and how it affects Something to Prove, so I won’t say more. But I hope to have news for you of a paperback and ebook of Something to Prove soon. Stay tuned.

– Yvonne S. Thornton, MD, MPH

 

Posted in Media appearances, Publishing news, Something To Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, The Ditchdigger's Daughters | No Responses »

Should you be worried about the blot clot risk with newer birth control pills?

Written by yvonnethornton on November 21st, 2011

You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.

But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.

So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.

YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.

But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.

– Yvonne S. Thornton, MD, MPH

 

Posted in Contraception (birth control), Fertility & Infertility, General health news, Pregnancy, Women's health issues, Women's health news | No Responses »
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HPV infections usually resolve on their own

Written by yvonnethornton on October 27th, 2011

It’s become common practice among some OB-GYNs to test for HPV, the human papilloma virus, due to the association of some strains of this sexually transmitted infection (STI) with cervical cancer.

But testing of women under the age of 30 is inadvisable. Because, although at least half of all sexually active men and women will get genital HPV at some point in their lives, the immune system will fight off and remove most of these infections from the body with no treatment. Seventy percent are gone within a year and 90 percent within two years.

It’s that 10 percent of cases we have to watch for. Some of those will lead to precancerous lesions in the cervix which, if left untreated, can develop into cervical cancer. But this process takes from 15 to 20 years. So, testing women under 30 for HPV leads to false positives, more testing, and perhaps invasive procedures in women who are at little or no risk of developing cervical cancer from HPV.

The American College of Obstetricians and Gynecologists (ACOG) therefore recommends that women under 30 not be tested for this STI, and I agree. If a woman under 30 has one of the high risk types of HPV, and if it persists, there will be ample time to find it and treat it. If she has one of the lower risk strains, it will probably be gone with no intervention within a year or two.

– Yvonne S. Thornton, MD, MPH

 

Posted in General health news, Women's health issues, Women's health news | 2 Responses »
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There’s much more to an annual pelvic exam than a Pap smear

Written by yvonnethornton on October 25th, 2011

You might have read that the U.S. Preventive Services Task Force now recommends that most women have Pap smears just once every three years instead of once per year.

Does that mean you can skip the OB-GYN appointment until 2014?

No, no, no, and no.

You must have a pelvic exam every year. Pelvic examinations save lives. A Pap smear, which can help identify cervical cancer, is just one part of that examination. Your OB-GYN does much more during your annual. She also looks for any evidence of ovarian cancer, vaginal cancer, myoma (fibroids) and other abnormalities of the reproductive tract.

And while it’s true that cervical cancer is typically a slow-growing cancer that takes an average 10 years to spread, sometimes these cancers “don’t read the books” and spread in a shorter period of time.

In my new health book, INSIDE INFORMATION FOR WOMEN, I tell you in greater detail what to expect when you have a gynecologic examination.

Don’t take risks with your health. Your “annual” is called that for a reason. Make sure you see your OB-GYN for your pelvic examination every year.

– Yvonne S. Thornton, MD, MPH

 

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