NewFNP is back from the most restful time she ever had in the state where she attended graduate school. Her school years there were full of studying and bad weather and really bad weather, whereas her Independence Day long weekend was full of tranquility, mild weather and relaxation with grad school pals.
Saturday, July 11, 2009
And now she's back and has questioned more than once why on earth she lives in the urban jungle when tranquility and waterfalls are available to her?? Ah yes, proximity to Barney's.
Her first day back in clinic was also her first day with her second ever student from her alma mater. It was a day filled with tough patients.
There was the 2-month old infant who would not make eye contact. Is it a retinopathy? Is it an early indicator of autism? NewFNP isn't sure. Ophthalmology consult!
Then there was the Mirena that twice fired prematurely with no assistance form newFNP. NewFNP felt like a nervous lover - and in front of a student! Eek. Her student later asked newFNP if that was a normal amount of nervousness for an IUD insertion, to which newFNP replied, "For newFNP or for the patient??"
Then there was the 20-year old G1P0 who was far more interested in picking at her thick French tips than participating in her prenatal care.
And finally there was the 19-year old G1P0 with a BMI of 55.5. No joke. She is 5-foot-1 and 294 pounds at 36 weeks gestation. She was 254 at her first prenatal visit.
NewFNP frequently reads lay articles and medical journals with stories and studies and statistics about the obesity epidemic. Fourteen is the new ten. Children are at risk. This will be the first generation to die earlier than previous generations because of the effects of obesity. The south is fat.
OK. NewFNP gets it - as a nation, we're fucking fat.
But please, please. Tell me just what in the world providers are to do? These are the avenues newFNP has attempted with her portly nullip:
1) just the facts, ma'am (health of mom and baby, labor complications, gestational diabetes risk);
2) supportive listening and encouragement (yes, it's hard to change our habits but you're doing this for your baby and yourself; yes life has dealt you a rotten hand -- let's change that for you and your baby!!);
3) stern lecturer (this has to stop - we are talking about the health of you and your child);
4) Richard Simmons (have you tried our prenatal yoga class??);
5) throwing the fruit punch in the trash.
And this is with one patient.
Obesity is a public health problem. This is not a problem that individual providers can address on a large enough scale to prevent and treat obesity. It's not that newFNP doesn't talk to her patients about their weight - she does. She talks to normal weight patients, underweight patients -- all 3 of them, and overweight patients about their weight. But that isn't enough.
Children are fed trash in public schools. WIC -- for all its great work -- gives away coupons for trashy foods. Parents give in to children's pleas for junk food. Poor urban areas are full of fast food options and liquor stores. Poor urban areas are not safe for outdoor play and exercise. Fruits and vegetables are expensive.
So what are we going to do? NewFNP is open to suggestions.
Congratulations and love to BostonFNP and BostonJD.