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awkward conversations in clinic

November 22, 2009 1 comment

so sometime in the recent past while taking a family history, my patient reported that her husband’s mother had a hysterectomy as a result of uterine prolapse. the husband then covered his ears and didn’t want to hear it, and reported that he didn’t know of this history, mostly jokingly.

i felt obligated to at least explain what his wife meant by “it was hanging low” to him. was that out of line? i’m not sure, but i had accidentally misinterpreted the writing on the family history form for another family member of “MVP – mitral valve prolapse” and “uterine fibroids” to mean all three of: MVP, uterine prolapse, and fibroids, and the clarification was what a conversation the three of us had earlier in her family history, which was why the idea of prolapse was brought up to begin with when we had moved on to his family history

medical histories and family histories are so revealing and often graphic to other family members in the room. I try and gauge what people say that makes others uncomfortable, but on the other hand, i tend to be a very matter-of-fact, this is what it is, it’s your family history take on it too. especially since we assume consent of the information if the patient brought that person into the room.

but it’s especially complicated because these are medical history information facts that my patient’s husband’s mother provided to my patient, and the husband perhaps slightly more oblivious to the details, didn’t want to hear. it’s just another gross female thing guys don’t want to hear about, right?

well, the damage is done i guess.

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finding the guys in genetic counseling, part 2

November 18, 2009 Leave a comment

As I’ve mentioned multiple times, voices from males in the genetic counseling field are few and far between. The following study from the Minnesota training program perhaps sheds a little light on the issue, although know the caveat that the conclusions and comments stem from only a sample of 3 male students.

From the following 2007 article, Schoonveld KC, Veach PM, LeRoy BS. What is it like to be in the minority? Ethnic and gender diversity in the genetic counseling profession. J Genet Couns. 2007 Feb;16(1):53-69., a few quotes from the 3 man-students that were interviewed:

“It’s like I’m an outsider. There’s this small group of us, and I’m always the one to be singled out or excluded …”

“I do feel that I was given the opportunity to interview at more schools because I am male”

“Patients always seem to think that I’m the doctor. It’s frustrating to get the question of ‘Why didn’t you go to medical school?’ from my patients! Like I couldn’t cut it, or like genetic counseling is somehow less of a field”

“A lot of the girls [sic] see things as since I’m a guy I was let in. So they set lower expectations for me and don’t expect me to do well”

“The people who interviewed me seemed to indicate that gender might be an obstacle. I almost felt like they were trying to deter me from the field”

“There are certain preconceived notions like, “He’s a guy, he’ll need more help with the feeling stuff.” Professors/supervisors seem to expect that I’ll know more of the medical/hard science stuff. Some of the professors or the male MDs still ask why I don’t go to medical school”

“It is really helpful to have him [my roommate, who is not in the program] around to sometimes just do guy things. It’s nice to talk about concrete things versus how I feel about things. He maintains my masculine sanity”

“I feel that I might be able to understand what the father is going through better than some females would …”

In comparing the experiences of males to those of other “minority” or self-identified “underrepresented” identity groups in the field of genetic counseling, the authors discuss:

Since the males had spent most of their lives in the majority vis-a-vis their gender, their more recent minority status as graduate students might be more distressing than for the female student participants who have a history of being in the minority because of their ethnicity.

In the present study, male participants appeared to be most adversely affected by their peer relationships. One male participant stated: “[my classmates] don’t even attempt to allow me to be a part of the group, but rather assume that we are so different it is not worth it.” It is unclear if a similar disparity exists among practicing genetic counselors, as all of the male participants in this study were students. Some participants sought out organizations or environments where they were guaranteed to interact with others from a similar ethnic/cultural group, especially the males, who expressed a need to do masculine things.

These above two comments are contrasted to the authors’ initial hypothesis:

1) Individuals identifying with an underrepresented racial/ethnic group would have more negative experiences within the field than would male participants

It definitely provides an interesting view of the experience of males, individuals of underrepresented racial/ethnic groups, and the potentially expanded implications on men who are of an underrepresented racial/ethnic group.

On another note, how about the actual practice between males and females? Heh. Good luck finding literature there. I did find the following article from 1984 (!!!!): Zare N, Sorenson JR, Heeren T. Sex of provider as a variable in effective genetic counseling. Soc Sci Med. 1984;19(7):671-5. Here are their conclusions from the study, taken with a few grains of salt, given that these ‘genetic providers’ were majority of an M.D. training background…

So.. “statistically significant” differences between many genetic-medical issues, but.. wait, no difference between socio-medical issues? Wait, let’s look at those numbers.. they’re all really low anyway so how useful is that information?

What’s interesting about the above data is “relationship with other children” under soci-medical. a difference of 25 to 5.9 isn’t statistically different? Again, low numbers.. I suppose?

What I’d be most worried about are the more counseling-aspects especially “raising a child with a birth defect”, “helped with most personal concerns” … but instead those were not statistically significant. What the authors claim was statistically significant (with a p-value of 0.06? no, that isn’t..) is “failed to ask about all concerns” with males faring worse.

The authors final conclusion:

Available data suggest that women patients seen by male providers. in genetic counseling at least, are likely to receive neither as exhaustive a discussion of selected basic medical and genetic topics, nor as much discussion of the specific topics they came to counseling to discuss. as do women patients seen by female patients.

Frankly, that’s a bit ridiculous based off of this data. Really? Gonna make those arguments based on a comparison of 8.6% to 17.6%. Oh, right, they’re MDs and not genetic counselors. And.. the study is 25 years old.

finding the guys in genetic counseling

November 17, 2009 3 comments

given that i get a few hits every week or so from individuals searching for “male genetic counselors” or something or other, i thought it’d be an appropriate time to speak a bit more about how i’ve gone about getting where i am in my understanding of men in the genetic counseling field. i’ve had a few posts in the past that have addressed some of the important issues, but how did i go about absolving the myth that male genetic counselors are inept at the counseling side of GC? with experience of course!

those experiences started with my first year in my program. UofM allows its students to elect a summer rotation of their choice. my first thought that I ended up sticking with was finding a location, a clinical rotation, where I’d be able to work with a male genetic counselor and get some experience seeing how he would work. given that ann arbor didn’t have any genetic counselor men locally, i started with speaking to my directors and seeing who they knew, or who had been an alum of the program (UofM hasn’t had a guy since the early 90s…).

another step I took was to look at who was credentialed, holding the CGC desgination. these people were more likely to be practicing, vs. working in a non-clinical job (so i thought). i browsed through all the pages of ABGC diplomates, and then google’d any male-gendered names i saw to see where they worked, if it was clinical, if it was in a location in the country i wanted to travel to, etc.  yes, i browsed through all 2500+ names looking and discerning for male-gendered first names. quite a task 😛

i ended up deciding on two locations that had a cancer focus, since i also had a particular interest in pursuing a fun, interesting, and involved cancer GC rotation. sent a few emails, got back a very welcome response and a second, polite decline (that was primarily due to the medical institution not being very appropriate to students), and i was set!

as the counselor who was my student liason first impressed on me (in our very first email exchange), it’s important to know that you can learn a whole lot from the counselors who are women that work there as well… and that basically sums it all up. it’s nice to work with another genetic counselor who’s a man, but when it comes down to learning the skills of GC, whoever it is that’s a good counselor will teach you tons and tons. some of my best counseling and career advice have come from those individuals at that rotation, so I absolutely lucked out (and made some great friends & professional relationships in the process!)

anyway, that’s been my experience. going to NSGC AEC is also an awesome way to scope out who’s a guy (it’s way easy, believe me, although i’m sure you don’t need to be convinced). there might even be guys that will address the topic too! (prominent example being Jeff Kopesky’s graduate research study and presentation at this year’s AEC on undergrad guys/girls in upper-level biology courses and their interest/knowledge of the genetic counseling field!)

not to mention, a lot of the training programs have at least a token guy (if not more!) maybe that’s a good place to start too. obviously, the bigger the program, or the bigger the city, the more likely there is to be a genetic counselor dude around, but, alas. hopefully this is can help someone out there.

Larry David’s “true ancestrial roots”

November 16, 2009 Leave a comment

here’s a funny video of Larry David’s experience with ancestry testing through the Ancestry by DNA test from DNA Diagnostics Center, as revealed on George Lopez. apparently their test uses 176 Ancestry Informative Markers, or AIMs. which ones these are and why they only test for European, Native American, Sub-Saharan African, and East Asian “BioGeographic Ancestry”, we don’t know without inquiring further. the references they cite are all from 2003 and before too..

Larry David is 63% European, 37% Native American.

“so I fail as a European?”

ain’t that interesting. it does make it seem a bit ridiculous/sensational, but funny indeed. their explanations of how these things work, however, aren’t the clearest thing:

ancestrybydna

methodology? heh.

from: TBS Lopez Tonight via genomeweb The Daily Scan

also check out: DNA and Race FAQ via AncestrybyDNA

check-in: NSGC Atlanta 2009

November 16, 2009 Leave a comment

just returned from the NSGC Annual Education Conference in Atlanta, Georgia. was able to meet a lot of new people, hear from a lot of new people, and take in all that is the annual conference.

i have to say the best part of the conference was seeing so many of the people i’ve worked with in the past, old classmates, and all these awesome genetic counselors and speakers that i’ve heard about over the past few years in one place. slyly peering at nametags and then once i figure out they’re someone important, whispering to classmates and friends to point out the awesome gc that just ignored me by texting on their iphone… guess they’re “real” people too, right?

catching up and networking aside, it helps to see what the current interests of others in the genetic counseling field as it currently stands (well, perhaps a few months behind the times given that submissions for abstracts, speakers, sessions are done in advance). attended the pre-conference symposium on counseling for genomic medicine. what was perhaps the most interesting was hearing about current models of practice and research experiences coming from Navigenics, Coriell Institute, Duke, and the Cleveland Clinic.

other interesting sessions included longer talks about addressing the need for genetic counselor involvement in training primary care providers (specifically PAs and NPs), and learning techniques to implement effective strategies to do those (basically, cut to the chase and give them just the information they need, when they need it).

another session spoke of developing genetic awareness campaigns and the different avenues genetic counselors can integrate into creating a media-based campaign to increase the general public’s knowledge of genetics, genetic counseling, or genetics services.

smaller meetings and talks were just as useful. attending the special interest group meetings really showed me how a lot of awesome projects happen on the SIG level, and that there are tons of opportunities to be a part of NSGC and those projects, on a volunteer level.

it’s really amazing how much involvement some individuals have in this organization, and the great things that come out of it.

it was nice seeing students/recent grads from different programs, too, that i’ve heard about, communicated with while writing my Perspectives article, and through fellow classmates and friends.

Atlanta was a blast as well. got to hit up some southern home cooking at The Colonnade, get some gourmet burgers and liquid nitrogen milkshakes from Flip Burger Boutique, and explore some fun neighborhoods and bars around the city, all thanks to my former classmate’s Zipcar membership.

all-in-all, it was a great time. learn lots, meet a lot of people, eat well, and play hard. it’s all in a long-weekend’s work 🙂 oh, and got some networking in there to boot and am now rethinking/reanalyzing my interests for my future career.

let’s just say i’m very intrigued by the intermingling of common complex disease, tons of need for genetics health education that incorporates the skills i’ve learned from school of public health, and one-on-one counseling that incorporates face-to-face as well as technology in the ways it should be better utilized.