I am a good standardized test taker. This is a good thing since beyond the basic tests everyone took in school I’ve had to take the MCAT, Medical boards (Steps 1, 2 and 3) and Pediatric boards. I’ll have to take the Pediatrics boards every 7 years for as long as I practice. I do believe that test-taking is a skill in of itself and not just a measure of intelligence or learning. I read fast. I have a good visual memory ( I can close my eyes when taking a test and visualize where on the page an answer is and then “read” it). And I have the ability to know what the great almighty “they” want from a test-taker. I’m not particularly proud of this ability, although I’m thankful for it and realize it’s made my life a lot easier.
That said, I’ve always been turned off by how important standardized tests have become in schools today. It’s one of the reasons we chose to homeschool. From that perspective, this expose of the standardized testing industry by Todd Farley confirms my feelings. It’s also quite shocking in what he reveals about the scoring of these all important tests.
Farley reveals a world where the testing companies hire scorers who often don’t care about the job, are overworked, and are often ignorant about the very subjects they are scoring. He exposes widespread cheating to have the tests meet reliability standards or to cover up scoring problems. Many of the stories in the book are so absurd that it reads as funny until you realize that this was real and some student or teacher or school had their life affected by these tests. For example, he tells of one “very nice” but incredibly dumb scorer who worked at scoring reading tests for three weeks. At the end of the time the scorer asks Farley what he’s being tested for, apparently thinking he’s been taking some kind of psychological test and not realizing he’s actually the one grading the tests. Farley explains to him that he’s not being tested but grading reading tests. The man says “I’m deciding if these kids are smart?” and looks at Farley with great shock.
In another example, the department of education representative from a state changes the way the tests are scored midway through because they are giving too many low scores. This means that the kids who were scored first are judged by higher standards than later kids. This particular story is even more disturbing because the test in question is one that is being used to decide if schools are “failing” or not and therefore will decide funding and impact teacher jobs.
The one off-putting thing about the book for me was that Farley worked in the standardized testing industry for 15 years before writing this book. On one-hand, it makes his stories credible. He knows testing. On the other hand, he is quite judgmental towards many of the people involved in testing but somehow never seems to have a mea culpa moment about his own involvement. He explains away every instance where he is the one cheating or lying or changing scores or keeping on scorers who are incompetent. I’m not sure it changes what he has to say, but it might have made me like him more if he’d taken some responsibility for his part in the industry.
Overall, though it’s a really interesting book and one I’d recommend, especially if you or your kids will be taking standardized tests anytime soon.
Yesterday, while driving to work I had a flat tire that ended up completely blowing and leaving me driving on the rim. It happened fairly quickly. I was aware that the tire was flat but I was in the far left lane at a toll plaza with no left shoulder. I was trying to get over to the right shoulder when I felt a big bump and looked in the rearview mirror to see the tire rolling down the road behind me. Not a sight you want to see. Luckily, due to the fact that there was a snowstorm the night before there was less traffic than usual on the road. Luckily, I was able to get over to the right shoulder without an accident. Luckily, even though I didn’t have a cell phone a police officer came by about 2 minutes after I pulled over. Luckily, because of the snowstorm when my office called the patients on the schedule were happy to have their appointments rescheduled and not have to come out in the snow. Luckily, even though the police officer had called a tow truck, the highway emergency people came by even faster and were able to put on the spare tire for me (saving much hassle of finding a ride to work and home later in the day). Luckily, the service station I later took the car to was able to fix it yesterday and we didn’t have to deal with the hassle of not having a second car for long.
I say “luckily” because I know that’s how this story would seem to a lot of people. A lot of luck and happy coincidences.
However, I really believe that this was a series of events showing God’s providence and care for me. From the police officer who just “happened by” not 2 minutes after I stopped to the snowstorm that kept me from having a bunch of frustrated patients waiting at the office when I came in over an hour late.
The obvious question though is why if God cares for me so much did the tire even fall off in the first place.
I was thinking about that this morning when I was out for a walk. I am a person who likes feel in control. I like making long-range plans. I am a worrier. In some ways, I think that is fine. God wants us to be good stewards of our time and money and talents and often planning can help with that. But I tend to fall into the trap of thinking that I am truly in control and that my plans are somehow the only way that things will be ok.
I think the tire incident was a way of gently showing me that I’m not the one in control. And that even when I haven’t planned (no cell phone) and don’t have the answers, the One who is control will care for me.
I posted last month about my idea to make monthly resolutions towards better health instead of making big vague New Year Resolutions that I’d ultimately fail at keeping. In January I gave up Diet Coke and it’s gone pretty well. I have had a few Diet Cokes since then, but it’s been a huge decrease. The big change I made was not to buy them or have them at home. Overall, I feel like it’s been successful and I’ve kept the spirit of the resolution if not strictly the law. I went from drinking more than I want to admit (think at least 4 a day) to drinking maybe 1 or 2 a week. So, a big change.
For February, I’m tackling something a bit harder. My goal is to exercise at least 3 days a week. Ultimately, I know 5-6 days is better, but in keeping with the spirit of making slow gradual changes, I’m starting with this. I don’t really enjoy exercise. Given the opportunity to spend an afternoon as I’d like, I’ll choose curling up with a good book or watching a movie or going to a museum or learning how to sew or just about anything other than a physical activity. I realize however, that exercise is really important to overall health and I know that when I actually do it I feel better.
You probably don’t remember, but I posted a similar goal of getting back to exercising regularly last January. And ultimately I failed. I had a lot of excuses, that are somewhat valid. I was really knocked out by nausea and fatigue early in the year with the pregnancy, then when that went away it was mid-summer and about 1000 degrees here and I just wasn’t up for getting out there, and finally I had a newborn and all the stress and fatigue that goes with it. I’m not claiming that these are good excuses, just that it’s reality. It’s still hard and I thought of a lot of excuses for why I shouldn’t yet tackle this challenge. The primary one is that it’s really difficult to carve out even 30 minutes in a day to do it. I round at the hospital every morning which makes it tough to also exercise then, during the day I am working or with kids, Ruth has not been great about napping in the bassinet so it’s rare to have 30 minutes where I’m not holding her for part of it, it’s cold and icy out now so I can’t walk outside which is my preferred form of exercise, etc. These are all true, but I also decided that in spite of or perhaps because of all of those I really needed to work on making it a priority.
So today I started with an exercise DVD I have. This isn’t my favorite method of exercise, but I like these. Plus, it’s something I can do and not have to worry about the complications of childcare or being outside. It went well. Ruth took a nap in the bassinet for the exact length of the DVD, which I found quite nice of her. John and David came down and watched me. Which is really another excuse I have not to exercise at home. It’s disconcerting to realize your kids are watching you flap around like a giant spastic dork. But I told myself I was setting a good example for them. If nothing else, it taught them that it’s ok to look silly.
I hope to report back in a month that I’ve been able to keep it up.
I saw a patient recently, we’ll call her Anne. She is a 8 yr old little girl who suddenly developed headaches about two weeks ago. The headaches aren’t severe enough to have caused her Mom to take her to the ER or for Anne to have missed school, but they have been fairly constant and obviously concerning to her and her Mom. She came in and saw us after about a week of the headaches and we recommended Ibuprofen, a typical first-line treatment for migraine-like headaches (which we see fairly often in kids). She tried that but the headaches persisted and the medicine didn’t really help at all, so they came back to see me. I recommended a CT scan . The insurance company is now denying the pre-certification for the scan (meaning they won’t pay if she has it) so I spent a great deal of time yesterday on the phone in a “peer-to-peer” review with one of the insurance company doctors trying to convince them that the CT scan is necessary.
I could try to explain all my reasons for wanting to do the scan and try to explain why the insurance company is saying no, but that would be a long and fairly boring post to anyone who isn’t in medicine. The bottom line is that I don’t have any of the reasons on the insurance company’s checklist for “reasons why you should do a CT scan for headaches” . Seriously, the doctor was reading me the checklist, they really have one.
I knew when I called that I didn’t, and so I knew that it is unlikely that I would be able to convince them to pay for it. However, what I know is my patient. That this little girl is one who doesn’t complain much. The mother isn’t one who brings her kids in very often. My gut feeling is telling me that it’s weird that she suddenly has constant headaches even if there aren’t any “red flags” from the checklist present. In the insurance company’s defence they don’t know if I’m just the kind of doctor who orders a lot of tests and is practicing “cover my but” medicine. Statistically, the insurance company has the odds in its favor. Most likely, the headaches are migraines or stress related. The chance that they are due to a tumor or aneurysm or some other more serious structural problem is pretty unlikely.They are willing to make that bet. I’m not.
The problem I have though as a doctor is that I’m being told what I should do (and doctors really don’t like being told what to do) by someone who hasn’t seen my patient. Who is playing a game of the odds using a checklist. Who last saw real patients, who knows how long ago. I don’t like having my judgment questioned by someone who is sitting at a desk with the luxury of not having to look the patient in the eye when they say “No”. It makes me mad.
I don’t disagree that health care reform is necessary and I realize that this anecdote is more about the current failures of the system than about reform. But my concern is that much of the talk centered around reform is about finding “best-care practices” and “reducing unnecessary tests”. I don’t have an answer to the problem. But I worry that it will only get worse.
My second book of 2010 was another winner. I’m not sure there is a lot that I can say about this book that hasn’t already been said. It’s gotten great reviews and won the 2009 Booker Prize. The back cover has a blurb from a review by The Guardian that describes it as “a non-frothy historical novel”. That’s a great description. I have to admit it took me a little bit to get into and at first I could see why it was a better book but guiltily thought to myself that I enjoyed the frothy historical novels more. But as I read, I became more and more drawn into the story and the beautiful writing. The story is about Henry VIII and Anne Boleyn but told from the perspective of Thomas Cromwell, an advisor to Henry VIII. I knew very little about Cromwell before reading this book and it is to the author’s credit that after 500+ pages I found myself wanting to know more. Mantel does a really wonderful job of making the political situation at the time fascinating and even more interesting than the scandal of Henry and his wives. I also found myself really intrigued by how Henry’s desire for divorce was used by many of his advisers to advance the Protestant Reformation in England.
Bottom line is that this isn’t a light or “frothy” read. But it is well worth the time commitment. Ultimately I’m sure it will stay with me longer than the more fun novels about the Tudors I’ve read.
I found this article on leisure time (or the lack of it) from last week’s Washington Post Magazine by Brigid Schulte very interesting. Schulte is a working mother who sets out to disprove sociologist John Robinson’s idea that women today have 30 hours a week of leisure time. She does a time study set up by Robinson where she writes down everything she does to the minute for seven days. Bottom line is that it mostly comes down to semantics. Robinson calls leisure anything you are doing that doesn’t clearly fall into another class like work or child-care. Exercise is leisure. Sitting around listening to the radio because you are too tired to get up is leisure. Watching movies with the kids is leisure. Schulte obviously disagrees and prefers the opinion of Rachel Connelly, a labor economist who tells her women today have virtually no leisure time because it’s all “contaminated time”. Meaning even during a leisure activity you are worrying about what to make for dinner or with the kids and having to mediate their fights. (Or you are out on a date with your husband to hear a favorite band but took the baby along, just for example.) Judging by this discussion, many readers agree with Schulte.
Being a working mother with three small children and also homeschooling I can sympathize with Schulte. True moments of pure planned leisure are rare. However, I came away from the story somewhat disappointed by the ending. It seemed that the time-diary she did only solidified her own pre-existing thoughts about leisure and didn’t really lead to any significant insight or change.
As I mentioned in this post, I think one of the reasons we are so busy today is that we like being busy. It makes us feel important and needed and many of our conversations involving one-upping each other with who is the busiest. Shulte briefly touches on this in her article when she interviews Ben Hunnicutt, head of leisure studies at University of Iowa. Hunnicutt tells her, “Work now answers the religious questions of ‘Who are you?’ and ‘How do you find meaning and purpose in your life?’.”Later when Schulte tells him that she is too busy to make time for leisure every day they have this exchange:
“Ah,” he said, “one of the Seven Deadly Sins.”
“Busyness-a sin?”
“‘In the Middle Ages, the sin of sloth had two forms,” he said. “One was paralysis, the inability to do anything- what we would see as lazy. But the other side was running about frantically. The sense that, ‘There’s no real place to go where I’m going, but, by God, I’m making great time.’”
Unfortunately, Shulte doesn’t explore this idea more. I say unfortunately, because I think that this explains a lot of why we don’t have true leisure time. We don’t value it and so we don’t make it a priority.
In the end, the article reminded me of the concept of “white-clouds” and “black-clouds” in medicine. Anyone in medicine knows that during training some residents and doctors will get the reputation of being a “white cloud” or a “black cloud”. A “white cloud” is someone who seems to always have an easier time, admit less patients, etc. A “black cloud” is pretty much the opposite, someone who seems to attract disaster. Medical people tend to be fairly superstitious (just walk into an ER and say something like “It’s pretty quiet in here” and see how many people yell at you for having “jinxed” them) and so once you have the label of being a white or black cloud you’ll find other people wanting to take call with you or dreading being on with you, depending.
The thing is several studies have looked at this and determined it’s all pretty much just superstition. In one study “black clouds” didn’t have any more of a workload or admit more patients but they did sleep less, perhaps because they were less efficient. In another study, there was no difference in workload or sleep between white and black clouds but there was a difference in their perception of their workloads and of their own luck.
The reason I thought of this after reading this story it that the crux of the story seemed to me the difference between Robinson and Shulte in their perception of what is leisure. I think what disappointed me in the end was that Shulte seemed to dismiss Robinson and look for an answer that suited her better. But I do think that just as there is value in thinking about why we might enjoy being busy, there is value in thinking about how we define our leisure time. I find that for myself if I think about the things I’m doing as somehow robbing me of precious “me-time” than I become resentful. If I try to think of them as things I choose to do and to find enjoyment in, I can often find that joy. As a Christian, part of it is starting to look at all my time as God’s and not mine. And the purpose of all of my time is for His glory.
I don’t mean to end by making myself sound holier-than-thou. I often find myself grumbling inside over the time spent picking up the toys for the 1000th time that day or supervising yet another potty break for David or folding yet another load of laundry. I’m not really thinking much about those tasks being to God’s glory. But I think I’d be happier if I did.
This weekend, H. and I got to go see one of our favorite bands, Eddie from Ohio at the Birchmere. It was a great show in a great venue and a rare treat to just have the time (semi-alone) together. We did take Ruth with us. She did great, pretty much slept through the show, including the loud drum solo. We also took her with us when we saw Avatar over the Christmas holidays, and she slept soundly through that as well. Yet another difference between a first child and a third child. We took John places at the same age but it seemed at the time like such a hassle…the diaper bag and worrying about him waking up or being fussy. It didn’t feel like a date. Now, one child is a snap and it’s definitely a date when it’s just the one who can’t interrupt our conversation.
We sat at a table with two other couples. One had an eight week old baby at home, one was pregnant with their first. They were sweet but I think a bit baffled by us bringing the baby. One of them asked if we’d been “following” EFO for a long time. My first thought was no, not really. Then we realized we first saw them before we were married, so about 11 years ago. Wow. It’s a cliché, I know, but sometimes life does seem to be moving at an incredibly high-speed. You wake up and boom, you have three kids and are married 10 years. Don’t get me wrong, I’m awfully happy with this life of mine. But sometimes I’m just amazed at how we got here. And wondering what tomorrow will bring.
One of the first things I hear when people find out I’m a pediatrician is something to the effect of how it must make parenting easier. And the answer is that it really doesn’t. It might make it easier to decide things like whether or not a cut needs stitches. But in the day-to-day nitty-gritty of parenting it doesn’t really help.
On the other hand, I do think being a mom has made me a better pediatrician. For one, it makes me more empathetic and compassionate. For example, when he was about 4 or 5 months old, John rolled off the bed. It was the classic situation where I didn’t know he could roll, I was close but not close enough and I saw him do it. I knew as a pediatrician that he was fine but as a parent….let’s just say I was pretty freaked out. Now when people had called before that about babies rolling off the bed, I had quickly reassured them but didn’t really understand why they were so hysterical. Now I give them the same advice, but I understand their level of worry and I am able to be more caring and just plain nicer.
More importantly, being a parent has taught me that babies are all different and parents are all different. For most parenting issues there is more than one way to do it “right”. Many times figuring out the “right” way for the parent-child combo means some trial and error. The place I learned this the most was with sleep. Before I had kids, I pretty much recommended the standard “cry-it-out” method of sleep training. I didn’t totally like it, but I didn’t really have a lot else to offer and most of the other pediatricians I knew (most with kids of their own) swore by it.
Then we had John. He wasn’t an “easy” baby that fell asleep without feeding or rocking. The cry-it-out method didn’t feel right to me as a parent. So we went with our gut instincts and he fell asleep always in our arms after being fed and rocked. We did all the “wrong” things but it ended up working fine. He’s six now and falls asleep fine on his own (although he likes to have his back scratched) and sleeps through the night soundly in his own bed (barring the occasional nightmare).
My approach to sleep then changed as a pediatrician. Now, I try to figure out what the parent’s personality is and what he/she wants rather than always recommending the same one size fits all approach. That idea has extended to other areas other than sleep. There are some things that I think everyone should follow (using car seats for example) but for a lot of parenting issues I see my job as more of a facilitator to help the parent figure out their own style and to offer suggestions for possible solutions, and not as someone who has the one right answer. Fast forward a few years and David came along and was a similar baby and our approach to sleep was pretty much the same with pretty much the same results.
Then we had Ruth. Up to the past week or so, she’s been fairly similar to her brothers. Likes to be snuggled, naps only in the sling if being held, sleeps a large part of the night with us, etc. We’ve done all those “wrong” things that have worked for us. However, recently she’s been really fussy with falling asleep even if she is in the sling or our arms. She’ll cry and cry and then finally exhaust herself and conk out.
Yesterday, I put her down in her bed while I was washing windows. She was happy for a while but then started to fuss. I would have gone and picked her up but I couldn’t because I had the windows unhooked and down. It took a few minutes to finish that task and by the time I did, she had fallen asleep on her own. With much less crying than she has had lately with us holding her. It was like a lightbulb went off…maybe this is what she’s been wanting. She napped pretty well and then the next time it was time for her to go to sleep, I tried it again. Same results. And again later in the day. Same results.
Now that was yesterday, and one thing parenting has taught me is that just because something worked yesterday doesn’t mean it will work again today. As I write this she is sleeping in the sling on me again. I admit I like her there.But I’ll also admit that having those times yesterday where she was not in the sling was also really nice. I noticed that she was in a really good mood when she was awake, if anything better than usual. H. and I laughed that maybe she’s thinking “Finally! I just needed some time alone.”
The lesson for me more and more is that each child is unique. That seems obvious. But it means that each time I think I have it figured out, I don’t. What works for one, might not be best for another. There is no cookie-cutter approach to parenting.
That’s a lesson that I think makes me a better parent. And also a better pediatrician.
Last year for the first time I chose a word to focus on during the year. For 2009 it was patience. I shared some of my thoughts on patience in the middle of the year. I can’t say that I’ve conquered my impatient nature but I did find the exercise of choosing a discipline to focus on to be helpful. I do think I’m overall more patient than I was at the beginning of the year.
Still, it is something I struggle with so I considered choosing patience again. After all, what could be more patient than realizing it takes time to develop patience. Very meta. I thought about choosing “love” as the word because one of the things I realized about my impatient nature is that often I am impatient with people because I’m not being loving towards them. For similar reasons I considered “compassion” and “empathy”.
But what I finally decided encompassed all those things to me is Grace. So that’s my word of the year.
These past few days I’ve been working on potty-training David in a much more full-on way than we have up to now. When we’re in the house, he is in underwear. It’s been going ok. Today though he had three accidents. The third was a really messy yucky poop. And of course I found out right as we needed to be leaving the house.
So, I calmly changed his pants and underwear and lovingly reassured him that accidents happen.
Nope. That’s what I should have done. I broke the cardinal rule of potty-training: Do not yell when they mess up and make them feel bad because you will cause shame and harm that will be irreparable and they will end up in therapy because of you or at the very least they will not potty-train until they are 16.
I yelled. I knew even then that I shouldn’t be but that only made me madder and more frustrated.
So with a lot of sighing and banging things around I got him changed and everyone into the car and got us out the door. I dropped John off at his music class. David had fallen asleep in the car so he, Ruth and I all just ended up hanging out in the car taking a nap. But before I napped I had awhile to reflect on my behaviour and how very un-grace-full it was.
What I realized in the car is that David messed up on accident. Yet my attitude was one of “How many times do I have to clean up these messes?” I feel magnanimous if I handle it well one time but it only takes a few times for me to lose my cool. I on the other hand didn’t have an “accident” but acted out in anger, a sin ultimately against God. And it wasn’t the first, or third time. There have been countless other times where I screwed up. But God had already forgiven me, even as I sat there in that van and felt like a small little bug. I knew I was forgiven in His eyes. I realized that is grace.
PS- For those wondering, I did sit down with both boys and apologize to them. (John was around when I was angry and although I wasn’t yelling at him, I felt he deserved an apology also.) I asked for their forgiveness and they gave it. With big smiles and big hugs.
I think maybe they get “grace” even if I have a lot to learn.
So, I started out the reading year with The Book Thief by Markus Zusak and it was a great way to begin. The book tells the story of Liesel, a young girl in Nazi Germany during World War II. The title of the book comes from the name given to Liesel by her best friend after she steals a book instead of food. One of the central themes in the book is the power of words, both spoken and written. At the beginning of the book Liesel is illiterate but her foster father gradually teaches her to read. As the book progresses, Liesel “collects” books that become more and more important to her as the novel progresses.
One of the more interesting things about this novel is that it’s told in the first-person but the narrator is Death. This is a device that could be gimmicky but I think overall was well-done. The use of Death allows the narrator to be omniscient and the author to use a lot of foreshadowing as a plot device that moves the story forward and keeps the reader interested.
I also found that I really cared about the characters in the book. They are believable and very real. I’ve read other fiction and non-fiction books about WWII and this was the first one that really made me think about what it would have been like for ordinary Germans during that time. That might not be a new perspective for some people, but it was for me.
Interestingly, this book has been marketed in the US in the Young Adult genre but was originally published in Australia as adult fiction. I’m not sure it matters, and probably more than anything it goes to show that the line between good fiction for high school age teens and good fiction for adults is pretty blurry or even non-existent.
Overall, a great read and one I would recommend.
