Archive

Posts Tagged ‘rotations’

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.

Advertisements

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.

respect to the MoD

i’ve always really respected the work that March of Dimes does and look up to their organization – both in terms of what they provide patients and providers in terms of information and resources, but also the position they hold in promoting ethically conscious decision making to prospective, expecting or new parents. just a few weeks ago, during a branch meeting, i showed a short, 5-min video by MoD that’s meant to introduce parents to newborn screening for a materials evaluation. needless to say, everyone had great things to say about the video and the many different places in which this simple video could be used effectively.

however, what’s more exciting is recent news of the MOD warning consumers about the risks of DTC Genetic testing and they’ve recently put up a new page on their website:  At-Home Genetic Tests: What You Should Know. absolutely a breath of fresh air coming from those wonderful people over in New York:

When it comes to your health and your baby’s health, your health care provider is the best person to help you decide what genetic test, if any, is right for you and your baby.

not to be rude or anything, but damn right! honestly, i am so pleased to finally see such a large and respected organization put the facts out there, in as simple a way as possible, in a manner that is beneficial for consumers/parents/patients, non-genetics professionals, and even genetics professionals who may be less familiar with the DTC trends going on currently.

a news desk article on their website continues:

Women are particularly vulnerable during pregnancy to sales pitches that play on a new mom’s fear and guilt.  Companies that offer the tests say they can predict a baby’s future height or athletic ability, or can assess the future risk of cancer, diabetes, Parkinson disease, or obesity.  The March of Dimes believes consumers should be very cautious before spending the money — and risking their privacy — on such tests.

once again, just making the same warning everyone else has been, but it’s nice hearing it from march of dimes. oooh i really do heart them. and their nifty booklets/paphlets/cheat-sheets they put out for providers that have all newborn or carrier screening info you’d ever want.

read more about it:

http://news.prnewswire.com/ViewContent.aspx?ACCT=109&STORY=/www/story/07-08-2009/0005056605&EDATE=

via

http://www.genomeweb.com/blog/blasting-dtc-genetic-dx-shops-march-dimes-statement-may-drive-more-people-use-cl

check-in

my research is taking the unfortunate turn away from an asian-american focus and looking more broadly at racially/ethnically diverse populations. okay, maybe that’s not unfortunate, but not what i’d initially envisioned at least. most importantly, i’m trying to decipher what the cultural and personal values are that influence the racial/ethnic disparities that we see in prenatal screening and testing uptake. but in designing this study, it really looks more at more broadly, what these values are, and how they influence a woman’s perceived severity of prenatal screening outcomes (the conditions that are screened for). rarely have the women themselves been asked “hey, what do you want screened on prenatal screening if it were your decision, how good/bad of an outcome would you consider those things, and would you consider screening or terminating over it?”. that’s the general gist. asking the client/patient themselves, what do they see as valuable Read more…

check-in

a lot has happened in the two months that i’ve abandoned this.

it really is amazing how serendipitously things in life happen. the hawaii internship turned out.. well, it didn’t, but after a lot of negotiating, i am now working with the equivalent group in california (yay for the bay area and home), working with their newborn screening branch. very very health education oriented which is even better for me since throughout this semester, i’ve really managed to focus my public health interests on the topics of both creating educational materials related to genetics and training professionals to increase their familiarity with genetics/cultural issues in the clinical setting that affects genetic counseling/etc. in addition to this internship, which you’ll hear all about throughout the summer if i remember to update, i’ll be rotating in the pediatric (+ metabolic?) genetics clinic here for four weeks at the beginning of august, two weeks of which will be supervised only by the medical geneticists that attend the clinic, since the supervising genetic counselor will be away on vacation. that’ll be an immense amount of responsibility, but everyone believes i can do it so i do too! this route (as compared to hawaii) has really allowed me to gain leverage and dictate exactly what i want out of my summer, which has really turned out in my favor. apparently i suck at phone interviews.

on the topic of my research. the survey class turned out well. i ended up creating my survey project on the topic of asian american women and their cultural influences on prenatal msAFP screening decisions, as specifically related to their attitudes/behavioral beliefs about outcomes from screening and their perceived behavioral control. the questionnaire, while yes, haphazardly put together since there’s not very good research and good survey instruments to use, was an interesting process and the process definitely was what was important for me to understand. i present it to the class tomorrow.

however, having gone through this survey, i’m starting to think i want to take a more qualitative approach to my actual GC research project, and focus on acculturation issues in general on the influence of msAFP screening, not just in asian-americans. having to decide how i was going to get a patient population was really difficult and required a lot of “pretending” on the respondent’s part, which as i’ve been learning, is tough to do because the attitudes are so subjective and dependent upon the situation. also, it’s hard to find a good cohort of age-appropriate female asian-americans here at the university of michigan (only 700 female asian american graduate students are here, which is limiting in and of itself, since a lot of them have very very specific backgrounds). i meet with several of my potential research mentors this week and next.

the MI class was great, ended today, and learned a lot of skills and really can see its applicability to genetic counseling. my final presentation can be glimpsed at below. the discrete skills will really be useful in my clinical work later on.

finally turned in the program proposal for the food desert issue in highland park as well. let’s just say that was painful and unnecessarily misguided.

which leaves me to my final major task for the semester: finishing up the mtDNA student seminar that was supposed to be presented in february but never managed to make it to completeion….

check-in

February 2, 2009 1 comment

i think i’ll start a new series of posts that i can use to keep myself on track and get a good idea of what’s happening in my training/coursework/projects/research/internship search and get my thoughts together regarding what needs to be done next.

courses

motivational interviewing today was great. we’re learning techniques of reflective listening, and attempting to be able to reflect complex thoughts, feelings, and issues back to our clients/patients by really getting them to explore. instead of just doing a “content reflection” as it’s called, we basically move the mirror to different Read more…

my first reach out

so having gone up to north for an outreach pediatrics clinic, let’ me just say. the snow really sucks! it’s everywhere, piled as high as the houses, and utterly impossible to drive at night when it’s blowing straight into the windshield.

however, i really enjoy this model of genetics accessibility. it certainly provides convenience to the families who live up north who can’t easily make the 3 to 4 hour to impossible drive (depending on snow conditions) down to any major medical center with genetics services. it’s a good way to provide continuing care for these individuals with genetics diagnoses. also it allows people with fewer means, more immediate Read more…