Tuesday, August 28, 2018

Adults: Vaccines are Not Just for Kids

By Alan C. Howell, MD, Temple

Member, Texas Medical Association (TMA) Be Wise — Immunize℠ Physician Advisory Panel and TMA Committee on Infectious Diseases

Vaccinations provide the best and most cost-effective way for physicians and patients to work together when it comes to preventing certain infections. For parents, this fact is reinforced by childhood vaccination schedules and school requirements. During National Immunization Awareness Month in August (and particularly now, during adult immunization week Aug. 26-31), let’s not forget that vaccinations remain an important pillar of health for all age groups, including adults

To understand what shots adults need, let’s review the Centers for Disease Control and Prevention (CDC) recommended immunization schedule for adults.

Zoster: A new, more effective vaccine to prevent shingles, a painful rash, now is available for adults aged 50 years and older. Shingrix was approved in late 2017. Soon after, the national panel that makes vaccination recommendations, the Advisory Committee on Immunization Practices, endorsed Shingrix over the existing Zostavax vaccine to prevent shingles and its complications. Shingrix provides greater and longer lasting protection from shingles, compared with Zostavax. Full coverage from Shingrix requires two doses administered two to six months apart. Adults are at risk for shingles, or herpes zoster, if they had chickenpox as a child. 

Tdap: All adults should receive a single Tdap booster to protect from tetanus, diphtheria, and acellular pertussis (whooping cough). After that, a tetanus (Td) booster is recommended every 10 years. A caveat to this is that pregnant women should receive one dose of Tdap with EACH pregnancy to protect themselves and their baby.

Pneumococcal: Pneumonia and bloodstream infections are two results of pneumococcal disease. Two vaccines are available to prevent the disease. Adults over age 65 and others with certain health conditions should receive both to provide the greatest protection. See the CDC guidelines about timing of the shots and specific indications

HPV: A vaccine to reduce the risk of cancer? Yes, please! Two to three doses are needed, depending if you get the shots before or after age 15. Females can get vaccinated through age 26. All males can get vaccinated through age 21, and some can get it through 26 years of age. 

Influenza (flu): I would be remiss if I didn’t include flu shots when talking about disease prevention. This past season was extremely severe and long. In fact, nearly 10,000 Texans lost their lives because of flu-related illness. We don’t know yet if the 2018-19 flu season will be as severe. Regardless, starting in September/October, the influenza vaccination should be a routine talking point between patients and their physician. Get your flu shot!

Though I touched on only five vaccinations, other shots listed on the adult immunization schedule are equally important, depending on age, lifestyle, and health conditions. Talk with your doctor to make sure you’ve had all the vaccinations you need. And, remember, no matter your age, vaccines are a valuable tool for everyone’s well-being. 

Wednesday, August 22, 2018

Preventing Heat Illness During Athletics This Fall

By Kelli Martinez, MD, Austin

Pediatric resident physician in her second year at The University of Texas Dell Medical School
Member, Texas Medical Association

Playing sports is good for young athletes because it improves their social skills, overall health, and school performance. However, as student-athletes return to school and practice while Texas’ extreme heat lingers from summer, they need to be cautious, and aware. There is a condition called exertional heatstroke that is easily prevented, yet young athletes still get very sick and even die from it each year.

Teen athletes can lose a large amount of water during practice and games. Doing so can affect their performance and could lead to heatstroke. It is important for the athlete to know warning signs of heat-related injury.

High school football players hydrate during practice.
The American Academy of Pediatrics set the following guidelines to prepare for exercise in heat and decrease the risk of heat-related injury.

Conditions that can contribute to heat illness during sports activities:

Heat and humidity;
Too much physical exertion too quickly, and not working up to getting the body used to it;
Wearing uniforms or equipment not made of breathable material;
Not drinking enough water before, during, and after practice or games;
Not being in shape;
Not getting enough sleep;
Not enough rest between same-day practices or games; 
Overweight/obesity; and
Current or recent illness and other conditions (or medications) that affect hydration status.

Recommendations to help avoid heat-related injury:

Athletes should be well prepared before participating in outdoor activities. Good hydration, good nutrition, and good fitness are most important.
Water and other fluids should be readily available and consumed during practice and games.
Athletes/coaches should limit time outside as much as possible, or change outdoor activity to be less intense:
  • Decrease length of practice,
  • Increase time and number of water breaks,
  • Wear as little gear as is safe for sport, and
  • Move practice/games to a cooler time of day.
A written emergency plan should be in place and practiced ahead of time for all games/practices.

Recognize the warning signs of heat-related injury:

Early recognition and treatment can decrease the severity of heat-related injury.
Possible signs of heat-related injury that should be reported immediately to coaches, trainers, or observers:

  • Exertional heat cramps: Athletes are sweating very heavily and describe muscle twitching that will develop into stronger muscle spasm. 
  • Heat exhaustion: Symptoms include weakness, dizziness, nausea, headache, elevated body temperature, and fainting. 
  • Exertional heatstroke: An extreme condition that includes confusion and seizures, and involves multiple body systems — and potentially, multi-organ failure.

If an athlete has any of the above symptoms, this is considered a medical emergency. 

Monday, August 6, 2018

Protect Your Baby by Getting Vaccinated During Pregnancy

By C. Mary Healy, MD, Houston
Member, Texas Medical Association (TMA) Be Wise — Immunize℠ Physician Advisory Panel and TMA Committee on Infectious Diseases

Pregnant women share everything with their babies. One of the most important things they share is protection against infectious diseases, protection that’s sometimes called “nature’s gift.”  When pregnant women have antibodies to infectious diseases, they share them with their baby before birth to help give early protection to the baby until he or she can be vaccinated or until the baby’s immune system is more mature. That’s why getting vaccinated during pregnancy should be a priority for every pregnant woman who wants to keep herself and her child healthy.  

The Centers for Disease Control and Prevention (CDC) recommends women get vaccinated against influenza (the flu) and pertussis (whooping cough) during each pregnancy, because both illnesses are dangerous for moms and infants. While some people consider flu a mild illness, it can be deadly for pregnant women and babies.  Healthy pregnant women, on average, are five times more likely to develop severe complications from the flu and require hospitalization, than women who are not pregnant. Some may die.  

Their babies also are at risk of complications if they get the flu, because they can’t be vaccinated until they are 6 months old. To be fully protected, babies need two doses one month apart. That delay puts them at risk for much of their first year (until that shot series is completed).  

Whooping cough generally is a mild yet annoying illness in adults. However, the disease is deadly in some young babies. Infants under 6 months of age have 20 times the risk of getting whooping cough compared with older children and adults, and — unfortunately for them — a high risk of suffering complications. Two-thirds of infants under 6 months who contract whooping cough end up in the hospital, and many suffer severe complications such as apnea (breath-holding), pneumonia, seizures, and brain damage. Some infants die. On July 17, a California infant tragically died from whooping cough, and a quick internet search will reveal many other similar stories.  Since 1990 almost everyone who died from whooping cough in the United States was under 3 months of age.

Fortunately, vaccines for influenza and whooping cough are available for pregnant women. These vaccines allow mothers to develop antibodies against the diseases that protect the mother against the infection and also pass to the baby across the placenta before birth. This means babies are born with high levels of antibodies that may last until they receive their own vaccines in the first months of life, and until their immune systems are better able to respond to the infection. Giving influenza and whooping cough vaccines during pregnancy has been shown to be safe and very effective in preventing infection in mothers and babies — much more effective than if the mother waits to get vaccines after the baby is born. And even if a baby is unlucky enough to get the flu or whooping cough, the illness is generally much milder.

Influenza vaccine should be given as soon as it is available, to make sure the pregnant woman is protected before the first cases of flu appear. Whooping cough vaccine should be given during the third trimester of pregnancy (between weeks 27 through 36), although it is safe to be given at any time. Giving it in the third trimester ensures antibodies are higher when the baby is born so the newborn is protected longer. Mothers who do not get these vaccines while pregnant should get them as soon as possible after birth (unless they have previously had the pertussis booster vaccine).

Equally important is that every person who comes in contact with babies (including fathers, grandparents, family members, and caretakers) is up to date on recommended vaccines. Getting the shots at least two weeks before they contact the baby is the best way to lessen the chance they will become sick and pass the illness on to the baby. 

Expectant moms should talk to their doctor about getting vaccines during pregnancy. While all pregnant women should get influenza and whooping cough vaccines during every pregnancy, some women may need additional vaccines if they are at higher risk of getting an infection or are traveling to certain areas. 

Pregnancy is a happy, exciting time for most women. Along with other important “do’s and don’ts” that moms-to-be follow, such as avoiding alcohol and smoking, taking special care around animals, and following a healthy diet, getting all recommended vaccines should be equally high on the list, so they can share their protection with their baby.  

Vaccines save lives and prevent disease, and vaccines during pregnancy can protect two individuals (mother and infant) with a single shot!

Friday, August 3, 2018

Doctors Reckon With High Rate Of Suicide In Their Ranks

 By Blake Farmer, Nashville Public Radio

This story is part of a partnership that includes Nashville Public RadioNPR, and Kaiser Health News.

Alarms go off so frequently in emergency rooms, doctors barely notice. And then a colleague is wheeled in on a gurney, clinging to life, and that alarm becomes a deafening wake-up call.

For Dr. Kip Wenger, that colleague, a 33-year-old physician, was also his friend.

Wenger is regional medical director for TeamHealth, one of the country’s largest emergency room staffing companies, based in Knoxville, Tenn.

“It’s devastating,” he said. “This is a young, healthy person who has everything in the world ahead of them.” His friend had confided in a few co-workers about recent relationship struggles, but none of that had affected her work.

The medical profession relies on the premise that doctors and medical staff, like highly trained endurance athletes, are conditioned to clock long hours, ignoring fatigue and the emotional toll of their work.

But, for many in the profession, that day-in-day-out stress can lead to crippling depression. It’s one reason doctors are far more likely than the general population to die by suicide.

A particular danger for doctors trying to fend off suicidal urges is that they know exactly how to end their own lives and they often have easy access to the means.

Wenger remembered his friend and colleague as the confident professional with whom he’d worked in emergency rooms all over Knoxville — including the one where she died. That day three years ago still makes no sense to him.

“She was very strong-willed, strong-minded, an independent, young, female physician,” said emergency doctor Betsy Hull, a close friend. “I don’t think any of us had any idea that she was struggling as much personally as she was for those several months.”

That day she became part of a grim set of statistics.

A Harsh Reality

An estimated 300 to 400 doctors kill themselves each year, and the suicide rate is more than double that of the general population, according to a review of 10 years of literature on the subject presented at the American Psychiatry Association annual meeting in May.

For TeamHealth, the young woman’s death in 2015 sparked some deep soul-searching.

“A few of these things happened that were just so sobering,” said TeamHealth co-founder Dr. Lynn Massingale. “People don’t stab themselves to death. Young people don’t stab themselves to death.”

It’s been an uncomfortable topic to address. A 2018 study from Mayo Clinic finds disenchanted doctors are more likely to make mistakes.

But TeamHealth held listening sessions and realized that burnout was rampant. To start, they began encouraging doctors to work less. Massingale said the company average is now close to 40 hours a week — though there’s no avoiding nights and weekends in the ER.

The company also started a new protocol for one of the most stressful times in a physician’s career: when doctors are sued. The company then pairs them with someone who has been there.

“We can’t change the facts. We’re not coaching you to change your memory,” Massingale said. “But we can help you deal with the stress of that.”

And TeamHealth is trying to reduce some bureaucratic headaches. A significant portion of the required corporate training has been deemed optional. And the company began spending millions of dollars a year to hire scribes — staff members who follow around ER physicians and enter information into sometimes finicky electronic health records.

Technology has become a real source of stress in a career that comes with lots to worry about, even beyond dealing with patients.

Dr. Jeffrey Zurosky, who is an ER director at Parkwest Medical Center in Knoxville, said he’s concerned for his youngest doctors who start out with a mountain of med school debt, eager to pick up as many shifts as possible.

“I tell them: Be balanced. Don’t overwork yourself. Spend time with your family. Stay married, if you can,” Zurosky said.

Yet to some in the medical community, the problem is far more fundamental than “burnout.” Pam Wible doesn’t even like the term, since it puts the burden on physicians, as if they just have to find a way to cope. The family practitioner from Eugene, Ore., sees it all starting in medical schools. Entrenched ideals, like muscling through long hours on little sleep, are hard to break. Wible calls it abuse.

“These people who have been previously abused are now the teachers,” she said. “They’re teaching the next generation of doctors.”

Too Close To Call For Help

And when physicians do want help, the industry makes it especially difficult. Wible said they can’t go see a psychiatrist without jeopardizing their medical license.

“I know a lot of them,” Wible said. “They’re having to sneak out of town, pay cash and use a fake name to do it. Why are we putting these people in such a situation?”

Wible has collected more than 900 stories of doctor suicides and set up an anonymous help line. She has inspired more physicians to share their experiences, such as an emergency doctor licensed in Ohio.

“You don’t focus on the 99 you save,” that ER doctor said. “You end up focusing on the one that you lose.”

The one he lost was 19 years old and came in with the flu, but tests didn’t show anything unusual. He sent her home. She returned in cardiac arrest. When he found out she died, he went to a dark place — despite no history of depression.

“Like all doctors, you put that Superman cape on and you think you can get through it,” he said.

The family filed a complaint. And being told he might lose his job pushed him over the edge. He swallowed a lethal overdose. But the police found him, and got him to a hospital where he had to be revived.

This ER doc had treated untold numbers of suicidal patients but never saw himself in their place.

“I didn’t know I was at higher risk of suicide than the average person,” he said.

Kaiser Health News and NPR are not naming this doctor because his story could affect his future career. But he said he wishes he could speak more freely, thinking it might encourage physicians to seek help sooner than he did.

Thursday, July 26, 2018

It’s Worth a Shot: HPV Vaccination is Cancer Prevention

If there were a vaccine against cancer, would you get it for your kids? HPV is a very common virus, infecting about 14 million people annually. This educational video by the Houston Health Department addresses this importance of adolescents receiving protection against HPV, a cancer-causing disease, and provides an overview of HPV vaccine recommendations. Physicians Julie Boom, MD, Lois Ramondetta, MD, Erich Sturgis, MD, and David Persse, MD, share their expertise, discuss HPV vaccine safety and talk about the importance of HPV vaccination.

Thursday, July 19, 2018

Fewer Women Need Chemotherapy for Breast Cancer

By Sidney C. Roberts, MD
Lufkin Radiation Oncologist

This article was originally published July 8 at the Lufkin Daily News and on the Angelina Radiation Oncology Associates blog. 

Less is more. When we find examples of that in medicine, we celebrate. In oncology — at least in fields like early breast cancer, where cure rates are high — the goal is to treat better, smarter — less — while maintaining high cure rates. In radiation oncology, strong scientific evidence has led to the widespread adoption of breast conserving surgery and radiation (less surgery) over mastectomy. Now, we have solid data from new study results indicating fewer women need chemotherapy as well.

It has taken a long time for that chemotherapy pendulum to swing back. In the 1980s, the prevailing mantra was high-dose chemotherapy for most women with breast cancer. Women even demanded and lobbied for the “right” to receive bone marrow transplants for aggressive breast cancers. My mother-in-law received a bone marrow transplant at an academic medical center in Lubbock, Texas. She stayed in the hospital for 30 days, much of that in the ICU, and nearly died from the treatment. Unfortunately, after recovering from the transplant she died from her cancer anyway. In retrospect, bone marrow transplant treatment for breast cancer can only be described as excessive, ineffective, and highly toxic. The scientific evidence just wasn’t there yet to support it.

Even putting aside bone marrow transplants, the promise of more and more chemotherapy that started around 1975 resulted in almost every woman with a cancer larger than a centimeter — not even a half inch — being recommended to get chemotherapy. That meant a lot of women being treated with undeniably toxic chemotherapy who didn’t need it.

Thankfully, many advances along the way have helped determine who may or may not benefit from chemotherapy. Breast cancers may have various proteins on their surface that cause them to grow when protein receptors are activated. Examples include receptors for hormones like estrogen and progesterone or growth-promoting proteins like HER2. Identification of the type of receptors on an individual woman’s cancer (for example estrogen receptor-positive), can guide certain treatment recommendations. In our modern era of often over-hyped personalized medicine, a test called Oncotype DX (developed in 2003) has revolutionized the way we decide who gets chemotherapy and who doesn’t.

Oncotype DX is a 21-gene analysis of a patient’s tumor that evaluates risk of recurrence with and without chemotherapy for women with early stage estrogen receptor-positive and HER2-negative breast cancer. The resultant individualized score predicts the likelihood cancer might return someplace else in the patient’s body within 10 years, and the likelihood of chemotherapy benefit for that particular patient. Physicians receive a report indicating their patient is in a low-risk, intermediate-risk, or high-risk group for recurrence. The practice until recently has been to offer chemotherapy in the high-risk group and to consider it in the intermediate-risk group as well.

On June 3, 2018, the prestigious New England Journal of Medicine published a practice-changing article that will have tens of thousands of women in the intermediate-risk group celebrating each year, because they, too, won’t have to have chemotherapy. This is one of those game-changer moments when the news hype is real. The test is anticipated to spare nearly 70 percent of women who previously would have had chemotherapy from having to endure the treatment. One of the study’s authors estimated around 60,000 women with breast cancer will benefit each year by not having to have chemotherapy.

In the U.S. alone this year, about 266,000 new cases of breast cancer will be diagnosed in women, and there will be about 41,000 deaths. Ninety-nine percent of patients with localized breast cancer survive at least five years! But women who won’t die from breast cancer don’t want to suffer through treatment they don’t need.

Breast cancer treatment remains quite complicated. There is not — and never will be — a one size fits all approach. Many women do need chemotherapy for breast cancer. Screening and early detection with mammography remain critically important to finding breast cancers earlier, when less aggressive treatments are much more likely to be recommended. Breast cancer treatment is an example where less can indeed be more.

Thursday, July 12, 2018

Why Medicine Rarely Runs On Time

By Andrea Eisenberg, MD
Michigan Obstetrician-Gynecologist

This article originally appeared on KevinMD.com and Doximity.

“Sorry, I’m running late … sorry, to keep you waiting.” How many times a day do I say that? Sometimes it is every time I walk into a patient’s room as if it is a normal greeting. Sometimes patients respond with: “Oh, you aren’t late” or “I haven’t been waiting long.” I can be so obsessed with not being late that I don’t realize I’m actually running on time! But I know it is a common complaint that patients “always” have to wait to be seen by their doctor. One of my senior partners at work used to say “waiting for a good doctor is like waiting to be seated at a good restaurant, it is worth the wait,” and never worried about time. I admired how thorough he was with his patients — I don’t think any of his patients felt rushed or not heard and came to expect waiting for his care.

Come join me for a day and see for yourself why medicine rarely runs on time. It’s not because we don’t try or we sadistically want our patients to suffer waiting naked in an exam room. It’s because, well, stuff happens and as the day rolls on, the stuff gets bigger, like a snowball rolling down a hill. That snowball is filled with the inconsistencies of life and patient needs that can be unpredictable.

Let’s start our day — Monday at 7:50 a.m. I arrive at my office, turn on the computer to see my patient list for the day and put on my white coat. While walking down the hallway, my medical assistant greets me as she goes in and out of each exam room, making sure they are stocked. I go back to my station to take a closer look at my schedule. I usually have patients scheduled every 15 minutes, but sometimes the slots are double booked if patients need to be worked in for an urgent issue or emergency. As I look at my list, there is the usual variety of annual exams, OB patients, IUD insertions, and colposcopies. There are also new patients — some with specific issues, some for just a check up — post-op checks, ultrasounds, and consultations about getting pregnant or how not to get pregnant. Some patients I know will be fairly quick, not having any issues and some take a little longer. Hopefully, they will balance out each other out so I can run on time.

8:20 a.m. I still have not seen a patient yet; my first one is late. 8:30am —now my 8 a.m., 8:15 a.m. and 8:30 a.m. patients have arrived within minutes of each other. It’s like the bus arrived and in one fell swoop, I’m already running late.

Next thing I know, one of my receptionists is coming towards me quickly, “Dr. Eisenberg, I have a patient on the phone that is eight-weeks pregnant and bleeding. What should I do?” “Tell the patient to come in,” as I look at my schedule, “at, um … hmm … at 10 a.m.” I know she needs to be seen — I hope I don’t have bad news for her.

I’m starting to get in my groove — I just finished with a patient, another is ready for me, and another is getting undressed. I need to send in a prescription for birth control pills for the last patient and I know I will forget if I don’t do it right away. So I get on the computer, but the wrong pharmacy is showing on the screen. I have to get out of that window and search for the right pharmacy. As I’m doing this, I hear overhead “Dr. Eisenberg, Dr. Smith is on line three.” The receptionist is now coming down the hallway to give me the chart for the phone call. “The doctor wants to talk to you about a mammogram report,” she says. I get into my multitask mode and answer the phone while electronically sending in the prescription.

Now, back to the patients in exam rooms. I walk into the next exam room where the patient is scheduled for an annual exam. She is a young college student and is excited to tell me she is dating someone. After we talk a little about how they met and what he is like, I ask “Are you using condoms?” “Ah, no,” she answers. So I take some time to talk about birth control options and STI prevention. She also was recently diagnosed with a seizure disorder, so I have to take that into account in counseling her about birth control. She decides she wants an IUD and we finally get to the exam.

I walk out of her room, ask my medical assistant to give her a pamphlet on IUDs, and start opening the chart for the next patient. As I’m about to open the door, my receptionist is waving me down. “There is a patient in the waiting room that just walked in. She thinks she is in labor and she looks like it.” “OK, bring her back now.”

I quickly go into the exam room I’m standing in front of, thinking I can see her before the laboring patient comes back. Luckily, this is a post-op check, and the patient is feeling fine, and after I review the surgery and pathology with her, she is ready to go. Next, I see the patient who thinks she is in labor. Her contractions are every five minutes, and she looks uncomfortable. I check her, and she is 4 cm dilated. “Time to go to the hospital,” I tell her. She is relieved that the pain is really labor. I leave the room, call the hospital to alert them as well as the on-call doctor who will likely deliver her baby.

By this time, I have completely lost track of time. I look at my watch. It is 10:30 a.m. and I have seen nine patients, written five prescriptions, answered two phone calls. My coffee’s cold, and now, I have a stack of lab results to go through in between seeing patients. I am running about 15 minutes behind — not bad. My 10:15 patient appears to be a no-show which helps me catch up a little. The early pregnancy bleeding patient hasn’t arrived yet.

Next up is a new patient. She is sitting in my office so we can talk. My medical assistant gives me a quick heads up as to why she is here and ends with “she has a stack of medical records.” She has a long history of issues with her periods, possible fibroids, heavy bleeding. It takes me awhile to sift through her story and her records. She ends with “I’m done. I just want my uterus out.” Once we are done talking, I tell her I need to examine her.

I walk out with her, show her where her exam room is and the bathroom. My medical assistant says, “You need to go into the ultrasound room next. The bleeder is in there.” When I enter the ultrasound room, the teary-eyed patient says, “Last night I had some spotting. I’ve never had this happen before when I’ve been pregnant.” I ask a few more questions, examine her and do an ultrasound. Fortunately, everything looks okay with the pregnancy, and the patient is relieved. “Thank you for seeing me today,” she said as I walked out of the room.

I continue on, and before I know it, it’s noon. Instead of taking my 30-minute lunch break, I use that time to catch up on charting patient visits and phone calls. I realize I haven’t even stopped to go to the bathroom, so I take a moment to do so and then pull out some snacks I have hidden under the counter. I have now seen 18 patients, answered five phone calls and electronically sent several prescriptions. I still need to call some patients about their lab results. That will have to wait for the moment, I have more patients to see and surgery after leaving the office.

I think you get the idea of how a doctor’s office flows, well, at least, at my office. We try to accommodate our patients’ needs and sometimes it takes a little longer than anticipated or a patient is scheduled for one thing and “oh, while I’m here, can’t you just also do …” Sometimes people have emergencies or urgent issues and need to be seen right away, even without an appointment. Sometimes people are late for appointments because of traffic or their babysitter came late, and then all patients after that get delayed. Sometimes patients call and need to talk to me at that moment instead of the end of the day. And sometimes, it is my doing — my cat throws up, my child is sick, I get a phone call walking out the door about my elderly parent, and I get to the office late. In the end, life gets messy and doesn’t run on time. Sometimes it helps me to I think of my schedule as more of a guide rather than a concrete time frame.

Believe me: As much as you want to be seen on time, I want to run on time. I like my day to flow smoothly, go home on time to see my family, make dinner, maybe even go for a run. But a doctor’s schedule is never nine-to five-because life doesn’t just happen between nine and five.

More importantly though, I want you to know that if you need extra time at an appointment, I will do my best to give it to you. And in return, I hope you understand if a patient before you needs that time, I will give it to her too and may see you a little later than your appointment time.

As I sit in my doctor’s waiting room for my check up, I too have to remind myself to take a breath, read a book, or play a game on my phone and be patient. I remember when I had an emergency, my doctor took the time to fit me into her busy schedule and address my urgent needs despite making her run late.

Dr. Eisenberg is a Michigan obstetrician-gynecologist. She blogs at Secret Life of an OB/GYN.
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