A Choice Environment

There is a new book out about how we make choices, The Art of Choosing by Sheena Iyengar. In her Voices of the Family interview, she discusses sex/gender differences and states "women have different choice environments than men" in that they have more social implications put upon them (and accepted by them) for their choices ("This blouse or that one?") and usually consider more variables when arriving at a decision. "I want" is answering the question easy or hard? Granted I want is a little different than I pick this or that. Here's sticky chart entitled "I want" from Dave Gray at Communication Nation - in his blog he has an interesting listing of 'wants' from a trainings he does.

In medicine, we ask people to make choices every day (and usually pretty quickly.) How can we best help others priorities and how can we motivate them to make their health a priority?Apparently, in Iyengar's book (haven't read it yet) she recommends focusing upon priorities and eliminating the extraneous. Easier said than done, I think! What are the implications of decisionmaking and anxiety?

BTW - Number of women with disability poll answer is 1 in 5!!

April - Women with Disabilities Awareness Month

Within sex and gender health disparities, there can be another layer preventing optimal health outcomes - disabled status. Many of your patients will have disabilities (even if they aren't visually apparent.) Be aware of bias - women living with disabilities often work; want excellent health care; are interested in sexual health; (based upon their age) are interested in family planning options; lead productive and happy lives and live with their limitations but aren't defined by them. Here's some stats and from our Canadian friends here's some more. Dr. Lisa Iezzoni has a video (long but useful video presentation) and information about barriers for women including tips on communication resources. Also, some powerpoints here and for women of color with disabilities.

Here's a cool resource on color limitation and disabilities. Here's information from the CDC, other resources about abuse awareness, also a general listing of topics for women with disabilities and here. This CDC resource gives guidelines and criteria to assess accessibility. Lastly, a Latino youth with disabilities resource.

Stay tuned for the answer to the poll!

Battle of the Bulge - Addressing the Bulge from Hibernation

So Philadelphia's weather is certainly summer-like. It enables us to shed our coats and problem solve in shedding our hibernation-induced pounds. Having most recently been overwhelmed by chocolate temptations, how do we start?

Well, first we need to see the linkages between the temptations and the behavior. Bored? Locked into an activity (like studying?) Too accessible? Down in the dumps or anxious? If you shut the (mouth) gate on temptations without addressing the cause, you'll likely be disappointed at your backsliding. So plan ahead.

Here's some tips:  1. You don't likely eat what you don't buy - dejunk your home. If all you have are carrots, well, that's what you'll nosh on.

2. Figure out the underlying issues. Bored? Try breaking up your routine. Even rearranging furniture can sometimes help. Locked in? Schedule a time to 'come up for air' - take yourself for a 15 minute walk. Bummed out? Spend time finding out why and scheduling things you enjoy (silly TV show that makes you laugh; time with a friend) Anxious? Find activities that help center you.

3. Exercise more. Even do chores or activities that get things done AND gets you exercise.
4. Here's ten more tips for healthier eating.
5. General pointer on reading a food label.

Human Trafficking

Having just given the IFM lecture on approach to a patient who's been assaulted, I mentioned that we didn't have time to cover elder abuse or human trafficking. Human trafficking is a growing problem. It is a problem throughout the U.S., not just in major cities with large immigrant populations. Here's a fact sheet with stats and information.

You can find trafficked people as street vendors (flowers, etc.) - all within the watchful eye of their captors. Some trafficked people don't even know that their situation is illegal - they come to the U.S. for a better life, for money for their family back home and how are they to know that they should not be locked in a house at night, have their wages taken and be abused.
Physicians and other health care providers may well be the first point of contact with trafficked people. They are brought in by their captors. Often their captors seem overly caring and speak for them (due to language barrier and because of  control) Physicians need to develop their antenna for trafficking. Here's fact sheets in different languages from DHHS. Children in prostitution and in trafficking mandate an automatic report. Helping adults is more complex.  The agency working on addressing human trafficking is the Dept of Labor. There is a national law preventing HT Trafficking Victims Protection Reauthorization Act of 2005. Getting people out of captivity and reporting the crime can occur if you report the finding. The downside is that it triggers an investigation in which the individual may or may not be deported. So they take a risk. But their life may be at risk in captivity.
Similar to IPV situations - separating oppressor from victim is key and getting a language translation service or individual can help.
Here's one example of a teaching unit on Trafficking from Mt Sinai/Osler/AMSA and Brown
Here's a nice powerpoint from the Floridian point of view:
Tips for the clinical exam:
At the very least - think about when you see dependent patients who are in low wage professions...they may be at risk. Knowing their options and sharing this with them can make a huge difference!

There is a Pennsylvania Lobbying Day to Prevent Trafficking on April 13th