justinesattendingadventures

[justinesattendingadventures]

Hey friends,

I changed my name again and am now Justine's Attending Adventures.

I deviated from the trend of Justine Survives Med School and Justine Survives Residency because I'm finally moving from surviving to thriving!

Follow along with me to find out what life is like for a new attending DO providing family medicine in a private practice!

[justinesattendingadventures]

My second week of attending life is going well. Setting up my desk, starting to see patients, and getting the hang of the EMR.

I am very much enjoying not having to go through seven layers of administration to get what I need anymore. I requested a specific type of needle for cervical blocks during IUD placements and I got a shipment the next day. Then I asked if I could get a point of care ultrasound for diagnostics, drainage, and injections and this Butterfly was on my desk less than an hour later!

Guest starring my lil window plants 🌱

[justinesattendingadventures]

First day of the new job after a relaxing two months off 🖤

I felt like a baby intern all over again even though I'm technically an attending now (finally!). New EMR, waiting on credentialing to get a login, shadowing another provider, etc. I'm very grateful that they didn't throw me in the deep end and have me see my own patients on day 1. However for someone who's finally done with training, I'm sure learning a lot. One of my coworkers who also just started on orientation graduated residency the year I was born so that's humbling too. Can't wait for that first attending paycheck though!

[justinesattendingadventures]

Hi Justine

Apprentice EMT here, Just wanted to ask you a quick question about pediatric patients if that OK with you?

I'm struggling to get babies and small children to not be scared in my presence when I'm trying to do my primary and secondary survey. Is there any advice you can give as a doctor regarding that? It doesn't help that I'm male, six foot, large build and have a deep voice. Do you have any advice regarding like posture?Or demeanour that I could use?

Thank you so much.

Muffin medic.

Hi Muffin Medic!

Congrats on your medical journey! Emergency medicine is always hard because it's a balance between getting things done as quickly as necessary and not scaring kiddos. If you wear masks, I will usually take down my mask, smile, and make a funny face before approaching them. Also if the situation allows, talking to their parent(s) first before doing an exam can set the example that you are someone their parent trusts.

When you approach the child, getting down to their level and possibly giving them a toy is helpful. When I was an EMT, we had some small stuffed animals to give to kiddos on the ambulance, and as a doctor it's usually stickers. Starting the exam, depending on their age I will usually show them what I'm going to do and what my equipment does before I do it (this is why stuffed animals were so helpful). Sometimes they're too young for that, but no matter what age they are, I will start from their feet and work up instead of the typical head-down adult assessment so that they get used to the exam.

All that being said, sometimes the emergent nature of the situation doesn't afford you time. In those cases, it's okay to make kids cry because the exam needs to be done. That was the hardest thing to learn because I want to help kids, not make them cry, but if we miss something, that's much worse for the kiddo than making them cry.

[justinesattendingadventures]

Congratulations on finishing!!

Thank you ❤️❤️❤️

[justinesattendingadventures]

I survived residency!

Yes I still have 7 days left...

But I have now officially graduated!

[justinesattendingadventures]

My personal favorite of our class photos

[justinesattendingadventures]

9 days left in residency and this is my class's favorite edit of our group photos lol our goal was to have the best class photo in residency history

[justinesattendingadventures]

My last hospital day shift was Thursday. This morning I completed my first of six night shifts of my last ever night float. In less than a week I'll be done with hospital medicine entirely. Very much looking forward to it.

[justinesattendingadventures]

I Have a Job!

I'm now realizing that this little medblr has been severely neglected during residency, but I'd rather neglect a blog than my mental health I guess. But hey I have a job! I'll be working at a private practice starting in September, doing family medicine (including pediatrics and gynecology), procedures, osteopathic medicine, and gender affirming care. I think it's a good fit for me and I like the idea of a salary rather than RVU based payment. I don't ever want to slip into thinking of my patients as money.

[justinesattendingadventures]

I Passed My Boards

It's a preliminary result but still feels good. Now I'm starting to apply for my full license which is hella daunting but I'm making headway. I'm currently on my last vacation in residency. Then I'm in the hospital for the next three weeks, two weeks of days and a week of nights. But then it's June and I'm just in the clinic until residency finally FINALLY ends!!

[justinesattendingadventures]

I just started a patient on HRT for the first time ever in our residency clinic!!

After ~2.5 years of residency, 1.5 years of building a LGBTQIA+ curriculum, 4 months of advocacy seminars, and a whole lot of barriers, we have finally gotten the okay to start initiating hormone therapy for the purpose of gender affirming care.

This patient is one of two who I had already started the evaluation and informed consent process. We had actually already decided on a plan to start estrogen, but this week the administration approved our official informed consent form so she came in, signed it with my colleague, and got to start estrogen tonight!!

This is a huge milestone for our clinic, residency, and community but also for me, my colleague (who has been a huge champion for all of this change), and of course my patient. I'm honestly a little bummed that I wasn't the one in clinic today to have the visit after doing all the evaluation and informed consent, but the excitement and progress is definitely worth it and I'm thankful for that.

[justinesattendingadventures]

Which intervention level (individual, interpersonal, organizational, systemic) resonates most with you? Describe an action step you intend to take to advance sexual and gender minority (SGM) health equity at this intervention level.

I have always been most fulfilled by making changes at the interpersonal level. Individual changes are probably the easiest to complete but don't have that same sense of fulfillment and organizational/systemic changes are often a bit too daunting and I become easily overwhelmed with so many changes needed.

I have already made some significant interpersonal interventions since co-creating a LGBTQIA+ family medicine curriculum. The one intervention that really left an impact was just openly discussing the community and their needs with a co-resident who was very hesitant about caring for this community and listening to the bad experiences she had had with a member of the community in the past. She felt heard and was then open to taking in more information and learned that several of her colleagues also belong to the community. I watched her become more engaged through further lectures and start to relate the SGM health issues to issues she has faced as a racial minority. She then graduated and went on to provide care for minorities of all types in Missouri, somewhere that desperately needs open minded people like the amazing doctor that I watched her become.

My next interpersonal action step is to teach our new interns about LGBTQIA+ competent care. They are all so excited to learn how to best treat all of their patients. Unfortunately, it is up in the air as to whether our residency will allow me to continue giving regular formal lectures on this topic as there has been a lot of push back from a few opposing individuals. Regardless, me and my colleague who developed the curriculum are seen as experts in this field of medicine, especially gender affirming care, and the interns have already started bringing all of their questions about that to us. While I have quite a ways to go before I consider myself an expert, I do have a lot of knowledge and resources at my disposal and I look forward to teaching them how to best treat all of their patients regardless of my ability to have formal lectures.

[justinesattendingadventures]

What happens when I don't finish my notes in clinic?

I usually try to finish my notes the same day, but sometimes mental health demands a rest. So here's a time lapse of me doing clinic notes on a sleepy Sunday morning ☕

Thank goodness for phone dictation apps.

[justinesattendingadventures]

How would you explain minority stress and minority resilience?

Before we discuss minority stress and resilience, we need to define allostatic load. My osteopathic medical school taught us about allostatic load before we learned anything else, so for me it is an integral part of medicine, but during this seminar I learned that not every medical school teaches this. Allostatic load is the sum of all the stressors that are affecting a patient, be that medical (hypertension/diabetes/flu/etc), psychological (depression/anxiety/schizophrenia/etc), familial (mom is sick/brother being deported/dad disapproves of you/etc), osteopathic (vertebrae out of alignment/rotated sacrum/stuck rib/etc), social (speaking only Spanish in an English speaking country/not having insurance/isolation from community/etc), or anything else that can affect the patient.

That makes sense, right? The more the patient has going on at baseline, the less reserve they have to deal with a new issue. So someone with a high allostatic load will be more affected by the same thing as someone with a low allostatic load.

Minorities by definition will then have a higher allostatic load than someone who is not a minority. So things that may not be catastrophic or overwhelming to a non-minority may be for a minority member. That is minority stress.

Minority resilience on the other hand, is when people can draw strength and community through their identity. A great example of this in sexual and gender minorities is pride month! Lots of people feeling joy and community being their true selves.

While minority stress is a good model to explain why minority individuals have higher rates of health issues and stress in general, it can also be weaponized against minorities in the media. For example, if queer folks have higher rates of depression, bigots may advocate for more conversion therapy because if they're no longer queer, they won't have depression. However in reality this is counterintuitive because it is not them being queer that is making them depressed but rather the stigma that our society places on them and the inequality that they face that contributes to the depression. If being straight was the minority, then straight folks would have higher rates of depression. It's not the identity, it's the societal repercussions.

[justinesattendingadventures]

Hi friends! It's been a while... Or is two years more than a while?

Anyway, I've continued to not only survive residency but also grow as a person and physician. Over the past two years, I have found my niche in family medicine moreso than just my OMT and behavioral health focus (which are both still going strong by the way). I have become one of the only providers of gender affirming care in my area and a fierce advocate for the LGBTQIA+ community.

Because of this, I have started to further my learning through a year-long LGBTQIA+ health fellowship seminar series. This program has requested I post a reflection on a blog after each seminar, and since I already have a blog, I figured why not post here and spread the knowledge to the medblr community.

Anyway, I just wanted to make an intro post explaining the posts to come so it's less weird when I start posting very specific/niche blog posts. As I stated before, I am a fierce advocate for the LGBTQIA+ community and I will literally just be posting my homework, so any anti-LGBTQIA+ comments will be deleted and the user will be blocked. I don't have time to debate strangers on the internet as to why human beings should be allowed to exist.

[justinesattendingadventures]

Yesterday I delivered a baby and ran a rapid where we let a DNR/DNI patient pass peacefully in the same inpatient shift. There is no other specialty in the hospital capable of doing that. Family Medicine is truly cradle to grave and it takes a special kind of person to do it.