“I spent a lot of time babysitting [my siblings] as a teenager and I think it’s been a challenge for me to separate out feeling like I’m a parent to them.”
This has often caused rifts between the siblings into adulthood, Rosenfeld says. “I’ve always been somebody who thinks it’s my job to offer help, care, and advice even when it’s not asked for.”
How does someone learn that becoming self-reliant is safer than trusting others? Nakazawa believes that in destructive parentification, “you don’t have a reliable adult to turn to.” And if a child’s early experiences at home consisted of making sure everyone else’s needs were met, then the “child doesn’t feel seen.
This sense of responsibility and compulsive caretaking can follow them into future relationships as well. “You tend to project it onto other people in your life,” Rosenfeld says. This isn’t surprising, claims Jenny Macfie, an associate director of clinical training at the University of Tennessee and another prominent parentification researcher, as “adults who report role confusion in their childhoods may have difficulty with their identity development,” and this in turn, can affect a person’s romantic relationships.
We’re only beginning to understand the interplay between sibling dynamics, parental neglect, and health outcomes later in life. We need to see more research on prevention and treatment options.
This is a really smart idea - raising awareness of the proper use of 911 is essential in order to reduce wait times for those in need by avoiding unnecessary interventions that do not require first responders.
The idea is this: If some people are going to use heroin no matter what, it’s better to give them a safe source of the stuff and a safe place to inject it, rather than letting them pick it up on the street — laced with who knows what — and possibly overdose without medical supervision. Patients can not only avoid death by overdose but otherwise go about their lives without stealing or committing other crimes to obtain heroin.
And it isn’t some wild-eyed theory; the scientific research almost unanimously backs it up, and Crosstown’s own experience shows it can make a difference in drug users’ lives.
Notions of willpower are easily stigmatizing: It becomes OK to dismantle social safety nets if poverty is a problem of financial discipline, or if health is one of personal discipline. An extreme example is the punitive approach of our endless drug war, which dismisses substance use problems as primarily the result of individual choices.
Such a fantastic read on a topic that permeates our health and social systems.
We’re starting our “metabolism” module at med school this week, and I’m dreading it with every fibre of my being. You see, I am going to be a doctor, and I am fat.
I’m not the type of fat you feel after you’ve had a big lunch, and your usually flat belly is protesting against the waistband of your jeans. I’m the real kind. My BMI hovers a couple of points below “morbidly obese”.
I worry a lot about what people will think of me as a fat doctor. For the smartarses among you, of course I’ve tried to be non-fat, it goes without saying. The thing is though, bodies don’t really like weighing less all of a sudden and are pretty good at reversing things in the long run. Mostly my body settles back to the same size 18 shape eventually.
I am always aware of my fatness, but perhaps more so here at medical school. We are training to work with bodies, and mine is a type of body we warn our patients not to have. It is the first thing described in every list of ‘modifiable risk factors’. A colleague suggests “just don’t let yourself get too fat” as we talk about preventing a certain type of cancer. A final exam question asks us to list four poor health outcomes associated with obesity. I sit through lectures with slides that have sniggering titles like “how BIG is the problem?”
For the first time during his hospital stay, his pain became real to me, and I realized I had wronged my patient by not taking his complaints more seriously. We gave him an opioid for his pain, and, slowly, the pain in his finger improved.
We’re taught in medical school not to undertreat pain, yet we do it too often in our zeal to not promote addiction. But many people who misuse opioids started out seeking pain treatment. We’re not doing enough, but what more can we do?
Don’t get me wrong. We absolutely need to continue to ask questions. We need to be more responsible when we prescribe these powerful drugs. And, yes, we need to remain vigilant for any signs of drug-seeking behavior.
That said, we have to be a little more trusting of our patients when it comes to their pain. Getting better control of their pain may help them recover faster and stay healthier longer.
With the opioid overdose epidemic, there is a palpable resurgence of very conservative pain management. We need to recognize that some people need opioids for pain management. Ultimately, substance use disorders and overdose are largely driven by disconnection, trauma, and stigma surrounding drug use, not the drugs themselves. Let’s evaulate and change the environments within which people are using drugs (i.e. address the social determinants of health, including employment, education, housing, and income). Limiting the conversation to restricting people’s access to medications obstructs a larger conversation on how our environments shape health behaviours.
“Hospice is not about dying. It is about living the remainder of your life how you want to. Not how I want you to, not how your husband, wife, daughters, or sons want you to, and not how the doctor wants you to, but how you want to.”
Sometimes, the way we frame something makes all the difference.
For patients with a history of sexual trauma, pelvic exams may trigger PTSD symptoms. The techniques of trauma-informed care can lead to an easier exam.
Studies show that trauma survivors want providers to ask about sexual trauma before the exam (that is, while the patient is clothed and seated). During the exam, patients prefer that the clinician listens, anticipates each step of the procedure, and affirms the patient’s control over the exam. For example, giving women the option of self-inserting the speculum has been shown to lower patients’ anxiety and pain.
Clinicians should use the following patient-centered techniques to lower patients’ anxiety:
Establish rapport before the exam. In some cases, this means doing the exam at a separate visit.
Invite the patient to suggest measures that will make her more comfortable with the exam.
Allow a support person to accompany the patient during the exam.
Allow the patient to choose a female examiner if she prefers this.
Before starting, inform the patient that the exam will stop if she feels uncomfortable. Assure her that she has control over the pace.
Tell the patient about each step of the exam right before it happens.
Keep the patient’s body covered, exposing only the areas being examined.
Encourage the patient to breathe abdominally in order to relax her pelvic floor muscles.
Rest the unopened speculum against the patient’s vagina so that she can get used to the sensation before the speculum is inserted and opened.
Use the smallest possible speculum.
Use lubricant.
Offer self-insertion of the speculum.
Offer frog-leg positioning without stirrups. Call stirrups “foot rests.”
If the patient does not want to continue the exam, the clinician should stop, inquire about the patient’s needs, and proceed only when the patient is ready.
This is how all exams should be performed - we never know who has experienced trauma.
Because there is no standardized curriculum for any medical discipline, by the mid-2000s, only half of Canada’s 17 medical schools offered some discussion about first-trimester surgical-abortion techniques. A recent study published in the journal Contraception found that in a third of schools, abortion isn’t raised in mandatory lectures at all.
This is appalling. Canadians seeking abortion deserve so much better. This is a procedure that a third of women under 45 have accessed.
The only nonbarbiturate sedative on the market from 1957 to 1962, thalidomide was a wildly popular sleep aid. Unaware of the risk for birth defects because of inadequate pre-market testing, pregnant women started taking it to treat morning sickness.
The thalidomide tragedy was the catalyst for the rigorous drug approval and monitoring systems in place at the FDA today ― the very ones that Trump wants to sidestep to speed up the drug-to-market process. All of which makes remembering the story of thalidomide crucial.
The Cheetoh-In-Charge needs to take a history lesson and remember why the FDA exists in the first place.
I think we’ve finally hit on what annoys me most about the commercialization of self-care: the idea that if we just take enough soothing actions then we won’t be tormented by the horror of being alive. This is a fucked-up expectation to set up for any depressed person, not to mention a way to cause further shame when taking these actions doesn’t work. Depression is an illness. No one would tell a person with cancer that if they just “inhale an upbeat smell” or “do a mini de-clutter” they are on the road to complete healing. So let’s maybe let the depression sufferers, and our doctors, address the depression. And the self-care bloggers can stick to $75 cashmere socks.
Though the next gadget or experience may bring fleeting pleasure, research shows that genuine happiness is about how we feel inside. To really enjoy the holidays, try these simple, research-based practices that will help keep you in a healthy state of mind.
My love for evidence-based decision-making obviously extends into the holidays. It’s no surprise that priming ourselves for good experiences, savouring happy moments, taking breaks, practicing gratitude, being generous, and connecting with our inner child all help make our holidays happier.
Al-Shifa Clinic relies on volunteer doctors to donate their time to serve all people, many uninsured or under-insured, free of charge. This is what compassion looks like in action.
Let’s support these wonderful folks and combat the hate aimed at people of Islamic faith following Trump’s election as President.
It can be helpful to visualize this number when talking about very small probabilities like dying in a plane crash and doing so can help put more pressing health conditions into perspective, such as the fact that we are approaching a time where 50% of people will develop diabetes in their lifetimes.
