Friday, February 26, 2010

It's not you, it's newFNP

NewFNP needs her head examined.

She gave notice at her research position and is going back to full-time community health. It's not as crazy as it sounds, she supposes. NewFNP has been spending a lot of time lately thinking about what kind of FNP she wants to be. (This is certainly something that her name brand nursing school did not teach.) High atop that list is that newFNP wants to be a community health practitioner. There certainly is a pride one feels when working in and for an underserved community.

NewFNP also wants to be a good teacher, a supportive listener, a knowledgeable medical practitioner, the type of person who says yes more often than she has in the past. This may be far more than newFNP can realistically achieve, but it is important to articulate and strive towards one's goals.

As such, starting early April, newFNP will be back in the thick of it. She hopes that she won't burn out so quickly this time around and that she'll have a lot of interesting tales to share.

That being said, she will miss working for her brilliant and hilarious research physician and her talented and creative research assistant. It is so hard to let people down.

Monday, February 15, 2010

Soda - two thumbs down

NewFNP was at the gym yesterday, reading the NYT whilst stationery biking. It's not her favorite workout, but yesterday was a day during which newFNP had to kill two birds with one stone. Thus, NYT and exercise together -- it's like church for newFNP.

The Week in Review section had a below-the-fold article about taxing soda written by Mark Bittman, whose bread recipes tend to be quite good, but whose sugar cookie recipe leaves something to be desired. Clearly, no manufacturer of any product is supportive of a tax on their wares, especially to the tune of 1 cent per ounce and when your product is being blamed as a component (and not an insignificant one) of the obesity epidemic. The industry quotes against such a tax were so transparently douchey, especially the one from one Mr. Derek Yach of PepsiCo who wondered if a tax on sugary food might make things worse by leading to an increased consumption of fat.

It should come as no surprise that newFNP supports such a tax. (She supports taxes on cigarettes as well. If marijuana were to become legalized, she would support a weed tax.) Soda has no nutritional benefits. Okay, okay, it has sugar. But overall, while tasting good, it is a piece of dump nutritionally speaking. When newFNP counsels newly diagnosed diabetics - something she does with alarming frequency - one of the first points she makes is that soda is a no-go, a killer, absolutely a never on the diabetic food pyramid. She believes that using the public health model that targeted cigarette consumption is a reasonable approach. After all, cigarette consumption has decreased significantly over the past few decades.

The article got newFNP thinking that there are other ways to decrease soda consumption. In newFNP's clinic, many, many of her patients receive food stamps. A quick trip to the national food stamp program website states quite clearly that the goal of the program is to help low-income families buy food that supports good health. Clearly, soda should not be on that list. Food stamps are a government program and the government already dictates some exclusions from the food eligibility list. For instance, alcohol is excluded, yet non-alcoholic mixers are not. Cigarettes are excluded. Flaxseed oil is excluded, yet cooking wine is okay. Hell, you can get bows and arrows with food stamps if you are lucky enough to live in Alaska!

If newFNP were asked to update the eligibility list, she would exclude all non-dairy sugary beverages. Good-bye Sunny D! You're not fooling anyone! See you later Orange Crush, you asshole. No one needs you! And no one would be about to do the Dew with food stamps.

But newFNP wouldn't stop there. No Hot Cheetos or any kind of chips. Knowing that food stamps and health are political issues, she might compromise and let Sun Chips or Baked Lays sneak by. No candy. No sugary cereals. No Lunchables. No Hostess, not even the delicious chocolate doughnuts that are so yummy on roadtrips home from snowboarding.

Yes, nutritious foods are expensive. Fresh fruits and veggies go bad if not eaten in a timely fashion. But frozen veggies don't. And if one's cart isn't piled high with a bunch of shit, the food stamps might go a little farther and actually work toward the program's goal of supporting healthy nutrition options in poor families.

And then move on to the schools. No soda dispensers and quit cutting recess and P.E. time. Seriously people - don't just have kids run the mile. Throw a kid a bone and help them to find a physical activity that they like, that they'll do for their entire lives. How about mat pilates P.E.? Hip hop dance P.E. class? Weight training. Not square dancing. Repeat - not square dancing.

Michelle Obama, if you're reading this, newFNP is here to help.

Saturday, February 13, 2010

It's all about the Hamiltons, baby!

NewFNP realized that she censors herself and that is so weak. So fuck it, let's talk about poverty.

It feels a little like a Seinfeld episode to say "not that there's anything wrong with it," but perhaps it is not entirely transparent that newFNP thinks that there is nothing wrong with being poor. That being said, there is also nothing wrong with wanting to not be poor either.

Poverty sucks. Urban poverty super sucks. Almost five years into practice, newFNP continues to be struck by the difficulties experienced by her patients -- difficulties truly unknown to her. Urban poverty often means gangs, school failure, cockroaches in ears, overcrowding, poor nutrition, medical debt, precarious housing, stress.

NewFNP grew up kinda poor after her parents divorced. Her dad often didn't pay the $400 child support payment that was to be shared between newFNP and broFNP. The first duplex in which we lived post-divorce was in the shadow of the interstate. But newFNP's mom had a college education and newFNP very frequently heard the mantra of the importance of a college education. And this was when she was in third grade. So while newFNP's family was financially poor, she had some socioeconomic buffer based on her mom's education.

NewFNP's patients, by and large, have no such buffer. They often live day to day, hand to mouth. Daily life beats them down enough that there is very little future orientation.

A patient today, a 30-year old unemployed woman with three children, eight year-old rippled breast implants and a tubal ligation, was interested in A) reversing her tubal in order to have another child with her boyfriend of four months and B) getting a do-over on the implants. Yes, get those rippled things switched out before something bad happens, absolutely. Yes, your health is worth the $5000 or whatever the new boobs cost. Reversal of tubal ligation? Likely very expensive and likely not covered by one's state-funded insurance program.

But are these out of pocket expenses financial priorities? Does she have Suze Orman approved savings? Do her children have college savings funds? Is it a universal truth that all parents want their children to succeed and be financially stable?? Does newFNP have any fucking business in encouraging her patients to think about such things or even thinking these thoughts in the context of patient care?

NewFNP doesn't know, nor is she any kind of sage financial guide. Lord know that if newFNP had an extra three grand laying around, she would have a Bertoia Bird Chair faster than you can say sham-wow!

But newFNP's gut says that even the least educated, financially marginalized champurrado vendor would prefer that her child be a teacher than sell shoes on a corner. But how does she help her child get there if she herself has no idea, if she's illiterate, if she hasn't set foot in a classroom since the 7th grade?

Or what is a family teaching their children if the parents don't work, if they hang out and watch TV and have state aid? Like, if the goal is state aid, end of story? If there are four fathers of four children?

(Is newFNP completely losing her liberal credibility for even thinking such things??)

There is definitely an argument that goes like this: NewFNP, just shut the hell up and see your patients for their ear infections, et cetera et cetera.

Then there is the argument that goes like this: People need help and they often come to clinic for more than just what their chief complaints might have one believe. And people who impact the lives of others do more than the bare G.D. minimum.

Perhaps she should adopt the former approach when she notes feelings of judgment towards a patient, as she did with the BTL-reversal wannabe today. Providing good medical care is, after all, a good outcome in and of itself.

But helping to teach someone avenues through which to escape poverty - that seems like an okay thing to do as well. Is that just too pie in the sky? Is it classist? Is it even a realistic goal given the constraints of clinic? Ah, fuck it. Who knows.