Sunday, August 17, 2008
StarTribune.com
A healthy dose of independence
By CHEN MAY YEE, Star Tribune
August 17, 2008
When Michael Oldenburg, a burned-out family doctor from Crystal, landed in Sweden for a sabbatical, he found "nirvana" -- doctors spent 30 minutes with each patient, took mandated coffee breaks and actually enjoyed their jobs.
When he returned, Oldenburg couldn't bear the thought of getting back on the treadmill. Last month, he and his wife opened what they called a "mom and pop" urgent care in Calhoun Village, installing kitchen cabinets from IKEA themselves and handing out fliers in the neighborhood.
He's among a sprinkling of Twin Cities doctors escaping the pressures of modern American medicine by striking out on their own. Some are offering "concierge care," where a limited number of patients pay a membership fee for 24-hour access to a physician. Even University of Minnesota Physicians is experimenting with a small clinic opening soon in Minneapolis' Warehouse District, where two doctors will make house calls on bicycles.
These experiments amount to tiny rebellions against increasingly large and impersonal health care systems and their emphasis on the bottom line. But they also speak to a hankering for something many doctors feel they've lost in the hurly-burly of seeing up to 30 patients a day -- the personal relationship between doctor and patient.
The same thing is happening around the country, said Dr. Pranav Kothari, co-founder of Renaissance Health consultancy in Cambridge, Mass.
Actual numbers are elusive and it's unclear how many will survive financially. "It is a trend, small but growing," Kothari said.
Forces favor group practices
In the 1990s, the spread of managed care sparked consolidation of medical and clinic groups that left the solo physician a dying breed. That's especially true in Minnesota.
It's particularly challenging for solo practitioners or small groups in primary care -- family medicine, pediatrics and internal medicine -- because they are reimbursed less than for specialty care. Many compensate by fitting ever more patients into the work day.
The number of solo family doctors in the state plunged from 89 in 1990 to 36 this year, according to the Minnesota Academy of Family Physicians. Two-person partnerships fell from 58 to 35. By contrast, the number of family medicine groups grew from 484 to 578 and multi-specialty groups soared from 489 to 738.
High overhead for billing, administration staff and now electronic medical records plus smaller payment from insurers make going solo daunting. Those who do it have to be very determined or very disillusioned, or both.
In 2002, Rochelle Taube left her group practice to start Edina Sports, Health and Wellness. Four banks refused her a small business loan before one loaned her $100,000 with her house as collateral. The practice was making money within four months and now has four doctors.
On a recent day, Taube saw 16 patients. "We have no desire to go fast," she said. "Patients like how you're not a number, you're a name."
She takes home about $60,000 a year, about $20,000 less than she used to.
Others who have gone independent are having second thoughts.
Five years ago, Alex Axelrod and a partner started a part-time cash clinic in St. Louis Park called AM Physicians. Axelrod is from Belarus and treats many immigrants lacking health insurance.
Last year, he left his full-time job at the Quello Clinic to focus on his cash clinic and another clinic for insured patients.
For complex patients, Axelrod often calls specialists and negotiates prices, going as far as tracking down charitable foundations to help pay a medical bill. His patients have his cell number.
But the 16-hour days are taking a toll. He's considering re-joining a big group.
Jon Hallberg, a family physician with University of Minnesota Physicians, is grateful he won't have to take such personal risks when he opens the Mill City Clinic in November.
His task, he said, is to create the "iPod of clinics" -- with same-day appointments, e-mail consultations and drugs delivered by Fairview Pharmacy right to patients' townhouses and condos. Hallberg expects to spend about 10 percent of his time doing house calls and is buying a bicycle.
To get to know his neighbors, Hallberg intends to host a regular evening at the Guthrie called "Hippocrates Cafe," where actors read short pieces on medicine.
"My charge is to make [the clinic] one of the highest in patient satisfaction in the system, if not the highest in the system," he said.
Lessons from Sweden
In his first job at a suburban Crystal practice with 18 doctors, Oldenburg saw up to 28 patients a day, spending just moments with each.
"I felt like I was running a marathon," he said.
After seven years, he and his family took a year-long sabbatical in a rural town in Sweden. Oldenburg, who emigrated from Stockholm at age 2, spoke Swedish but not "medical Swedish." He wondered if he was up to the challenge.
The Swedish doctors were equally worried about his American ways. The clinic chief swiftly laid down the rules. Oldenburg was to take a half-hour morning coffee break, like everyone else, and then a lunch break from noon to 1 p.m. and another half-hour afternoon coffee break. During these breaks, he was to socialize with his co-workers, including lab and cleaning staff, and there was to be no shop talk.
Oldenburg was stunned. In Minnesota, doctors routinely ate lunch at their desks, sandwich in one hand and tape recorder in the other. When his patients said they would miss him while he was gone, he realized he could scarcely remember who they were.
In Sweden, with 30 minutes for each patient, he had time to chat not just about their ills but about their lives. "Before I knew it," he said, "I was in love with medicine again."
He knows Swedish health care, funded by taxpayers, is not perfect. Those seeking specialty care often wait months. But he liked a lot of what he saw. American medicine, he concluded, is "very efficient but not very effective."
Going solo
When he returned in 2005, Oldenburg knew he wanted his own clinic. He rented an office in St. Louis Park and started doing immigration exams for people seeking green cards. He moonlighted at urgent care centers in the evening.
Oldenburg looked into "concierge care," an idea that's taken off in other cities. Some doctors here are experimenting with it, but as a solo practitioner, Oldenburg didn't think he could handle being on call after hours.
In early July, Oldenburg opened a 2,000 square-foot clinic called TCMC Urgent Care above a Hollywood Video store in Calhoun Village.
The small reception area is decorated with a vase of flowers and an oil painting by Oldenburg's uncle. A small refrigerator holds vaccines and there's a used X-ray machine.
His wife, Niki Oldenburg, handles the clinic's insurance contracts. Billing is outsourced. He can't yet afford health insurance for his full-time nurse and part-time medical assistants. His own family is covered through his wife's University of Minnesota job. Oldenburg says he's sunk a quarter-million dollars into the new clinic. Counting equipment accumulated over two years and the fact that he didn't pay himself during that time, he's invested up to $1 million to get where he is today.
He's seeing about 10 urgent care patients and doing about five immigration exams a day. He hopes business picks up.
"It's just like having children," Oldenburg mused. "If you'd known [what it would take] before you did it, then you might think twice or not have done it at all."
Chen May Yee • 612-673-7434
© 2008 Star Tribune. All rights reserved.
A healthy dose of independence
By CHEN MAY YEE, Star Tribune
August 17, 2008
When Michael Oldenburg, a burned-out family doctor from Crystal, landed in Sweden for a sabbatical, he found "nirvana" -- doctors spent 30 minutes with each patient, took mandated coffee breaks and actually enjoyed their jobs.
When he returned, Oldenburg couldn't bear the thought of getting back on the treadmill. Last month, he and his wife opened what they called a "mom and pop" urgent care in Calhoun Village, installing kitchen cabinets from IKEA themselves and handing out fliers in the neighborhood.
He's among a sprinkling of Twin Cities doctors escaping the pressures of modern American medicine by striking out on their own. Some are offering "concierge care," where a limited number of patients pay a membership fee for 24-hour access to a physician. Even University of Minnesota Physicians is experimenting with a small clinic opening soon in Minneapolis' Warehouse District, where two doctors will make house calls on bicycles.
These experiments amount to tiny rebellions against increasingly large and impersonal health care systems and their emphasis on the bottom line. But they also speak to a hankering for something many doctors feel they've lost in the hurly-burly of seeing up to 30 patients a day -- the personal relationship between doctor and patient.
The same thing is happening around the country, said Dr. Pranav Kothari, co-founder of Renaissance Health consultancy in Cambridge, Mass.
Actual numbers are elusive and it's unclear how many will survive financially. "It is a trend, small but growing," Kothari said.
Forces favor group practices
In the 1990s, the spread of managed care sparked consolidation of medical and clinic groups that left the solo physician a dying breed. That's especially true in Minnesota.
It's particularly challenging for solo practitioners or small groups in primary care -- family medicine, pediatrics and internal medicine -- because they are reimbursed less than for specialty care. Many compensate by fitting ever more patients into the work day.
The number of solo family doctors in the state plunged from 89 in 1990 to 36 this year, according to the Minnesota Academy of Family Physicians. Two-person partnerships fell from 58 to 35. By contrast, the number of family medicine groups grew from 484 to 578 and multi-specialty groups soared from 489 to 738.
High overhead for billing, administration staff and now electronic medical records plus smaller payment from insurers make going solo daunting. Those who do it have to be very determined or very disillusioned, or both.
In 2002, Rochelle Taube left her group practice to start Edina Sports, Health and Wellness. Four banks refused her a small business loan before one loaned her $100,000 with her house as collateral. The practice was making money within four months and now has four doctors.
On a recent day, Taube saw 16 patients. "We have no desire to go fast," she said. "Patients like how you're not a number, you're a name."
She takes home about $60,000 a year, about $20,000 less than she used to.
Others who have gone independent are having second thoughts.
Five years ago, Alex Axelrod and a partner started a part-time cash clinic in St. Louis Park called AM Physicians. Axelrod is from Belarus and treats many immigrants lacking health insurance.
Last year, he left his full-time job at the Quello Clinic to focus on his cash clinic and another clinic for insured patients.
For complex patients, Axelrod often calls specialists and negotiates prices, going as far as tracking down charitable foundations to help pay a medical bill. His patients have his cell number.
But the 16-hour days are taking a toll. He's considering re-joining a big group.
Jon Hallberg, a family physician with University of Minnesota Physicians, is grateful he won't have to take such personal risks when he opens the Mill City Clinic in November.
His task, he said, is to create the "iPod of clinics" -- with same-day appointments, e-mail consultations and drugs delivered by Fairview Pharmacy right to patients' townhouses and condos. Hallberg expects to spend about 10 percent of his time doing house calls and is buying a bicycle.
To get to know his neighbors, Hallberg intends to host a regular evening at the Guthrie called "Hippocrates Cafe," where actors read short pieces on medicine.
"My charge is to make [the clinic] one of the highest in patient satisfaction in the system, if not the highest in the system," he said.
Lessons from Sweden
In his first job at a suburban Crystal practice with 18 doctors, Oldenburg saw up to 28 patients a day, spending just moments with each.
"I felt like I was running a marathon," he said.
After seven years, he and his family took a year-long sabbatical in a rural town in Sweden. Oldenburg, who emigrated from Stockholm at age 2, spoke Swedish but not "medical Swedish." He wondered if he was up to the challenge.
The Swedish doctors were equally worried about his American ways. The clinic chief swiftly laid down the rules. Oldenburg was to take a half-hour morning coffee break, like everyone else, and then a lunch break from noon to 1 p.m. and another half-hour afternoon coffee break. During these breaks, he was to socialize with his co-workers, including lab and cleaning staff, and there was to be no shop talk.
Oldenburg was stunned. In Minnesota, doctors routinely ate lunch at their desks, sandwich in one hand and tape recorder in the other. When his patients said they would miss him while he was gone, he realized he could scarcely remember who they were.
In Sweden, with 30 minutes for each patient, he had time to chat not just about their ills but about their lives. "Before I knew it," he said, "I was in love with medicine again."
He knows Swedish health care, funded by taxpayers, is not perfect. Those seeking specialty care often wait months. But he liked a lot of what he saw. American medicine, he concluded, is "very efficient but not very effective."
Going solo
When he returned in 2005, Oldenburg knew he wanted his own clinic. He rented an office in St. Louis Park and started doing immigration exams for people seeking green cards. He moonlighted at urgent care centers in the evening.
Oldenburg looked into "concierge care," an idea that's taken off in other cities. Some doctors here are experimenting with it, but as a solo practitioner, Oldenburg didn't think he could handle being on call after hours.
In early July, Oldenburg opened a 2,000 square-foot clinic called TCMC Urgent Care above a Hollywood Video store in Calhoun Village.
The small reception area is decorated with a vase of flowers and an oil painting by Oldenburg's uncle. A small refrigerator holds vaccines and there's a used X-ray machine.
His wife, Niki Oldenburg, handles the clinic's insurance contracts. Billing is outsourced. He can't yet afford health insurance for his full-time nurse and part-time medical assistants. His own family is covered through his wife's University of Minnesota job. Oldenburg says he's sunk a quarter-million dollars into the new clinic. Counting equipment accumulated over two years and the fact that he didn't pay himself during that time, he's invested up to $1 million to get where he is today.
He's seeing about 10 urgent care patients and doing about five immigration exams a day. He hopes business picks up.
"It's just like having children," Oldenburg mused. "If you'd known [what it would take] before you did it, then you might think twice or not have done it at all."
Chen May Yee • 612-673-7434
© 2008 Star Tribune. All rights reserved.
Wednesday, August 13, 2008
The New York Times
August 10, 2008
Op-Ed Contributor
The Descent of Men
By MAURICE ISSERMAN
Clinton, N.Y.
WILCO VAN ROOIJEN, a Dutch mountain climber, managed to survive the debacle this week that took the lives of 11 others in Pakistan on K2, the world’s second-highest peak. Describing the chaotic events that ensued when a pinnacle of ice collapsed and swept away fixed ropes that climbers from several expeditions high on the mountain had counted on to aid their descent from the summit, Mr. van Rooijen lamented: “Everybody was fighting for himself, and I still do not understand why everybody were leaving each other.”
Himalayan mountaineering is an inherently dangerous pastime, and climbers are always at risk from the unexpected. But mountaineering has become more dangerous in recent decades as the traditional expeditionary culture of the early- and mid-20th century, which had emphasized mutual responsibility and common endeavor, gave way to an ethos stressing individualism and self-preservation.
The contrast between the two eras is vividly illustrated by the experience of an earlier expedition that ran into peril on K2. Fifty-five years ago this month, Dr. Charles S. Houston, America’s premier Himalayan mountaineer, led a team of seven Americans and one British climber attempting a first ascent on K2. They made steady progress up the mountain, and by Aug. 1 all eight climbers had reached a campsite at 25,300 feet. From there, given good weather, they expected to reach the 28,251 foot summit in two days.
Instead, they were pinned down by a blizzard in their high camp for the next week. And one member of the team, Art Gilkey, who was on his first Himalayan venture, was struck down by a case of thrombophlebitis, a clotting in the veins, in his left leg. It left him unable to walk and in danger of death if a blood clot were to reach his lungs. Houston and the others knew that there was little chance that they could carry an incapacitated man 9,000 feet down treacherous slopes to the safety of base camp. But they did not for a minute consider leaving their teammate behind.
On Aug. 10, they started down the mountain. Gilkey was sedated with morphine, wrapped in a sleeping bag, and alternately towed and lowered by his comrades. The climbers descended in roped pairs and, when they could, held their partners on “belay” — that is, one climber would keep a tight, protective hold on the rope as the other made his way down the slope. Encumbered as they were, and with the storm raging, it took them six hours to descend a few hundred feet from their camp.
At around 3 p.m., the eight men were arrayed across the slope to the west of one of their previous campsites, Camp VII, their destination for the day. Gilkey in his sleeping bag was belayed from above by Pete Schoening, a climber from Seattle. The other climbers, roped in pairs, stood nearby.
Suddenly, one of them lost his footing, and as he fell he pulled his partner off his feet. They became entangled in the ropes of the other climbers, until practically the whole party was slipping downwards toward a precipice. Schoening remained on his feet, but his rope was entangled with the others. If he had fallen, it would have been the end for them all as they would have tumbled thousands of feet to their deaths on the Godwin-Austen Glacier below. If there had been no surviving witnesses, the 1953 American K2 expedition could have entered mountaineering lore as one of those enduring puzzles to be endlessly debated in the climbing journals, like the disappearance of George Mallory and Sandy Irvine on Everest in 1924.
But at that moment of impending doom, Schoening saved them all. In his effort to belay Gilkey down a rock cliff, Schoening had jammed his ice ax into the snow behind a small boulder, wrapping the rope once around the ax and then around his waist. When he saw the others fall, he instantly put all his weight onto the ax. The nylon rope stretched and tightened on him — but it held, and Schoening held.
Several of the climbers, including Dr. Houston, were injured. They could go no farther that day. They would have to work their way over to Camp VII and set up the two tents they were carrying to get shelter for the night if they were to survive, and they could not do it with Gilkey in tow. For the moment, they left him anchored to the slope with ropes and ice axs, about 150 feet west of the campsite. Another climber, Bob Craig, explained to Gilkey, who was sedated but conscious, that they were leaving him for a short time but would return. “Yes, I’ll be fine,” Gilkey told Mr. Craig, “I’m O.K.”
They got their tents up. In the distance, they heard through the howling wind what sounded like a shout from Gilkey. Then there was silence. In a few minutes, three of the climbers returned to check on their injured teammate. To their horror, they saw that the gulley was now empty. Gilkey was 27 years old when he disappeared; he had completed his doctoral thesis in geology at Columbia University on the day he departed for K2. In the years that followed, the others would wonder whether he had been swept away by an avalanche, or caused his own death, somehow releasing the ropes that held him in place in an act of self-sacrifice that allowed the rest of them to live.
It took the survivors five more days to fight their way off the mountain. Finally on Aug. 15, they reached base camp. They built a 10-foot high cairn as a memorial for Gilkey on a rocky point near the confluence of the Savoia and Godwin-Austen Glaciers. It stands there to this day.
The K2 expedition became legend among mountaineers, its members honored for the gallantry of their conduct under extreme conditions. As Nicholas Clinch, a rising American climber, would write a few years later, the “finest moment in the history of American mountaineering was the Homeric retreat of Dr. Houston’s party of K2 in 1953.”
Houston himself summed up the highest ideals of expeditionary culture when he wrote of his K2 comrades: “We entered the mountains as strangers, but we left as brothers.” Today in contrast, as was evident last week on K2, climbers enter the mountains as strangers and tend to leave the same way.
Maurice Isserman, a professor of history at Hamilton College, is the co-author of the forthcoming “Fallen Giants: A History of Himalayan Mountaineering From the Age of Empire to the Age of Extremes.”
August 10, 2008
Op-Ed Contributor
The Descent of Men
By MAURICE ISSERMAN
Clinton, N.Y.
WILCO VAN ROOIJEN, a Dutch mountain climber, managed to survive the debacle this week that took the lives of 11 others in Pakistan on K2, the world’s second-highest peak. Describing the chaotic events that ensued when a pinnacle of ice collapsed and swept away fixed ropes that climbers from several expeditions high on the mountain had counted on to aid their descent from the summit, Mr. van Rooijen lamented: “Everybody was fighting for himself, and I still do not understand why everybody were leaving each other.”
Himalayan mountaineering is an inherently dangerous pastime, and climbers are always at risk from the unexpected. But mountaineering has become more dangerous in recent decades as the traditional expeditionary culture of the early- and mid-20th century, which had emphasized mutual responsibility and common endeavor, gave way to an ethos stressing individualism and self-preservation.
The contrast between the two eras is vividly illustrated by the experience of an earlier expedition that ran into peril on K2. Fifty-five years ago this month, Dr. Charles S. Houston, America’s premier Himalayan mountaineer, led a team of seven Americans and one British climber attempting a first ascent on K2. They made steady progress up the mountain, and by Aug. 1 all eight climbers had reached a campsite at 25,300 feet. From there, given good weather, they expected to reach the 28,251 foot summit in two days.
Instead, they were pinned down by a blizzard in their high camp for the next week. And one member of the team, Art Gilkey, who was on his first Himalayan venture, was struck down by a case of thrombophlebitis, a clotting in the veins, in his left leg. It left him unable to walk and in danger of death if a blood clot were to reach his lungs. Houston and the others knew that there was little chance that they could carry an incapacitated man 9,000 feet down treacherous slopes to the safety of base camp. But they did not for a minute consider leaving their teammate behind.
On Aug. 10, they started down the mountain. Gilkey was sedated with morphine, wrapped in a sleeping bag, and alternately towed and lowered by his comrades. The climbers descended in roped pairs and, when they could, held their partners on “belay” — that is, one climber would keep a tight, protective hold on the rope as the other made his way down the slope. Encumbered as they were, and with the storm raging, it took them six hours to descend a few hundred feet from their camp.
At around 3 p.m., the eight men were arrayed across the slope to the west of one of their previous campsites, Camp VII, their destination for the day. Gilkey in his sleeping bag was belayed from above by Pete Schoening, a climber from Seattle. The other climbers, roped in pairs, stood nearby.
Suddenly, one of them lost his footing, and as he fell he pulled his partner off his feet. They became entangled in the ropes of the other climbers, until practically the whole party was slipping downwards toward a precipice. Schoening remained on his feet, but his rope was entangled with the others. If he had fallen, it would have been the end for them all as they would have tumbled thousands of feet to their deaths on the Godwin-Austen Glacier below. If there had been no surviving witnesses, the 1953 American K2 expedition could have entered mountaineering lore as one of those enduring puzzles to be endlessly debated in the climbing journals, like the disappearance of George Mallory and Sandy Irvine on Everest in 1924.
But at that moment of impending doom, Schoening saved them all. In his effort to belay Gilkey down a rock cliff, Schoening had jammed his ice ax into the snow behind a small boulder, wrapping the rope once around the ax and then around his waist. When he saw the others fall, he instantly put all his weight onto the ax. The nylon rope stretched and tightened on him — but it held, and Schoening held.
Several of the climbers, including Dr. Houston, were injured. They could go no farther that day. They would have to work their way over to Camp VII and set up the two tents they were carrying to get shelter for the night if they were to survive, and they could not do it with Gilkey in tow. For the moment, they left him anchored to the slope with ropes and ice axs, about 150 feet west of the campsite. Another climber, Bob Craig, explained to Gilkey, who was sedated but conscious, that they were leaving him for a short time but would return. “Yes, I’ll be fine,” Gilkey told Mr. Craig, “I’m O.K.”
They got their tents up. In the distance, they heard through the howling wind what sounded like a shout from Gilkey. Then there was silence. In a few minutes, three of the climbers returned to check on their injured teammate. To their horror, they saw that the gulley was now empty. Gilkey was 27 years old when he disappeared; he had completed his doctoral thesis in geology at Columbia University on the day he departed for K2. In the years that followed, the others would wonder whether he had been swept away by an avalanche, or caused his own death, somehow releasing the ropes that held him in place in an act of self-sacrifice that allowed the rest of them to live.
It took the survivors five more days to fight their way off the mountain. Finally on Aug. 15, they reached base camp. They built a 10-foot high cairn as a memorial for Gilkey on a rocky point near the confluence of the Savoia and Godwin-Austen Glaciers. It stands there to this day.
The K2 expedition became legend among mountaineers, its members honored for the gallantry of their conduct under extreme conditions. As Nicholas Clinch, a rising American climber, would write a few years later, the “finest moment in the history of American mountaineering was the Homeric retreat of Dr. Houston’s party of K2 in 1953.”
Houston himself summed up the highest ideals of expeditionary culture when he wrote of his K2 comrades: “We entered the mountains as strangers, but we left as brothers.” Today in contrast, as was evident last week on K2, climbers enter the mountains as strangers and tend to leave the same way.
Maurice Isserman, a professor of history at Hamilton College, is the co-author of the forthcoming “Fallen Giants: A History of Himalayan Mountaineering From the Age of Empire to the Age of Extremes.”
August 12, 2008, 11:02 am
Six Ways to Be a Better Patient
Last week, the Well blog featured “Six Rules Doctors Need to Know.” So what about patients?
Dr. Robert Lamberts, the August, Ga., physician who wrote the original rules in his blog, Musings of a Distractible Mind, says it was easy to criticize his own profession, but it’s tough to turn the spotlight on patients. That said, patients are half of the doctor-patient relationship, and they need a few rules of their own. Here are his six rules for patients.
Rule 1: Your doctor can’t do it alone.
The best doctor can do very little with patients who ignore instructions. Sometimes noncompliance is partly due to physicians not explaining things well, but medical compliance is ultimately in the hands of the patient. I am mystified as to why some patients will ignore nearly everything I say and yet continue coming in for regular appointments.
Rule 2: Be honest.
I think the main reason most people are untruthful is that they are embarrassed about the truth. While I can sympathize with this feeling, I don’t see any good reason to be anything but truthful with your doctor. Yes, your symptom might sound strange. Yes, you may have flubbed up and not followed instructions properly. Yes, you may be afraid of what some of your symptoms may mean. But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility.
Rule 3: I don’t play favorites.
I have over 3,000 patients. I try to do right by all of them. I build relationships over years and even develop quasi-friendships with some patients. But I am professionally obligated to keep emotional distance. Overly liking or disliking a patient will cloud my judgment, and so I try to treat everyone the same. It drives me (and my staff) crazy when patients come in and demand “special treatment” because “Dr. Rob knows who I am.”
Doctors I take care of can be the biggest offenders. I try to make it clear from the outset that I will treat them like any other patient and not necessarily give them better access because they are doctors.
Rule 4: Don’t mess with the staff.
My staff takes an incredible amount of abuse at the hands of some of my patients. It surprises me what they are willing to say to my nurses and clerical staff but not to me. In general, people see them as an obstruction to being able to see their doctor, and so have little patience for any delay. There are certainly times that my staff is worthy of criticism, and I expect to hear some complaints. But in general, it is not the individual staff’s fault for things not running well. If they don’t meet your expectations, yelling at them won’t fix the problem. Talk to me or my office manager. Better yet, put it in writing so that I have ammunition to change things, because chances are really good that your frustration correlates to a frustration I have.
Rule 5: If you don’t trust, leave.
People go to the doctor because doctors have unique knowledge and experience. The stakes are as high as they can get, so why would you go to someone you don’t trust? I have seen many patients stick with doctors in whom they have lost faith “because I don’t want to hurt his feelings.” That is ridiculous. It does not matter if everyone else says this is a good doctor; if you don’t trust him, find another doctor.
Please note that trusting a doctor does not mean you should not ask questions. In fact, I think a physician who does not want to be questioned is one you should not trust. Questioning is often the only way to build trust.
Rule 6: No news might be bad news.
Never assume that your doctor will call you if there is a problem. A doctor’s office is always on the brink of chaos — with an incredible amount of information coming in and going out, a large number of phone calls, insurance company headaches, and personnel situations that can throw the best system flat on its face. People forget that there are hundreds of other patients with thousands of test results the office is dealing with. We do what we can to tell patients test results (and with our computerized records, we do a better job than most), and I see that as our responsibility. If you don’t get your test results, call.
Six Ways to Be a Better Patient
Last week, the Well blog featured “Six Rules Doctors Need to Know.” So what about patients?
Dr. Robert Lamberts, the August, Ga., physician who wrote the original rules in his blog, Musings of a Distractible Mind, says it was easy to criticize his own profession, but it’s tough to turn the spotlight on patients. That said, patients are half of the doctor-patient relationship, and they need a few rules of their own. Here are his six rules for patients.
Rule 1: Your doctor can’t do it alone.
The best doctor can do very little with patients who ignore instructions. Sometimes noncompliance is partly due to physicians not explaining things well, but medical compliance is ultimately in the hands of the patient. I am mystified as to why some patients will ignore nearly everything I say and yet continue coming in for regular appointments.
Rule 2: Be honest.
I think the main reason most people are untruthful is that they are embarrassed about the truth. While I can sympathize with this feeling, I don’t see any good reason to be anything but truthful with your doctor. Yes, your symptom might sound strange. Yes, you may have flubbed up and not followed instructions properly. Yes, you may be afraid of what some of your symptoms may mean. But the goal is to fix (or prevent) problems, and trying to do that with bad information is an exercise in futility.
Rule 3: I don’t play favorites.
I have over 3,000 patients. I try to do right by all of them. I build relationships over years and even develop quasi-friendships with some patients. But I am professionally obligated to keep emotional distance. Overly liking or disliking a patient will cloud my judgment, and so I try to treat everyone the same. It drives me (and my staff) crazy when patients come in and demand “special treatment” because “Dr. Rob knows who I am.”
Doctors I take care of can be the biggest offenders. I try to make it clear from the outset that I will treat them like any other patient and not necessarily give them better access because they are doctors.
Rule 4: Don’t mess with the staff.
My staff takes an incredible amount of abuse at the hands of some of my patients. It surprises me what they are willing to say to my nurses and clerical staff but not to me. In general, people see them as an obstruction to being able to see their doctor, and so have little patience for any delay. There are certainly times that my staff is worthy of criticism, and I expect to hear some complaints. But in general, it is not the individual staff’s fault for things not running well. If they don’t meet your expectations, yelling at them won’t fix the problem. Talk to me or my office manager. Better yet, put it in writing so that I have ammunition to change things, because chances are really good that your frustration correlates to a frustration I have.
Rule 5: If you don’t trust, leave.
People go to the doctor because doctors have unique knowledge and experience. The stakes are as high as they can get, so why would you go to someone you don’t trust? I have seen many patients stick with doctors in whom they have lost faith “because I don’t want to hurt his feelings.” That is ridiculous. It does not matter if everyone else says this is a good doctor; if you don’t trust him, find another doctor.
Please note that trusting a doctor does not mean you should not ask questions. In fact, I think a physician who does not want to be questioned is one you should not trust. Questioning is often the only way to build trust.
Rule 6: No news might be bad news.
Never assume that your doctor will call you if there is a problem. A doctor’s office is always on the brink of chaos — with an incredible amount of information coming in and going out, a large number of phone calls, insurance company headaches, and personnel situations that can throw the best system flat on its face. People forget that there are hundreds of other patients with thousands of test results the office is dealing with. We do what we can to tell patients test results (and with our computerized records, we do a better job than most), and I see that as our responsibility. If you don’t get your test results, call.
Tuesday, August 12, 2008
The New York Times
August 10, 2008
Op-Ed Columnist
Keeping It Rielle
By MAUREEN DOWD
WASHINGTON
John Edwards’s confession was a little bit breathtaking.
Not the sex stuff. That happens here all the time.
And certainly not covering up the sex stuff. That happens here all the time, too. First people uncover; then they cover up. Nobody’s ever had sex with that woman until, suddenly, they have.
The stunning admission Edwards made to ABC’s Bob Woodruff, and in a written statement from Chapel Hill on Friday afternoon, was that he’s a narcissist.
He admitted that wallowing in “self-focus” out on the trail and thinking you’re “special” can result in a solipsism that “leads you to believe you can do whatever you want, you’re invincible and there’ll be no consequences.”
Auto-psychoanalysis by the perp. That’s really rich. When Bill Clinton acknowledged an affair, after equally adamant denials, he simply went into an old-fashioned spiral of penitence, his allegedly long, dark night of his alleged soul.
Even in confessing to preening, Edwards was preening. His diagnosis of narcissism was weirdly narcissistic, or was it self-narcissistic? Given his diagnosis, I’m sure his H.M.O. would pay.
The creepiest part of his creepy confession was when he stressed to Woodruff that he cheated on Elizabeth in 2006 when her cancer was in remission. His infidelity was oncologically correct.
So narcissist walks into a New York bar and meets a legendarily wacky former Gotham party girl — whose ’80s exploits were chronicled in a novel by her former boyfriend Jay McInerney because the behavior of her and her friends “intrigued and appalled me.” When you appall Jay McInerney, you know you’re in trouble.
The president manqué gives Rielle Hunter, formerly Lisa Druck, more than $114,000 to shoot vain little videos for his Web site (even though she’s a neophyte), one of which is scored with the song “True Reflections” about the Narcissus pool, which goes: “When you look into a mirror, do you like what’s looking at you? Now that you’ve seen your true reflections, what on earth are you gonna do?”
He has an affair with Hunter, while he’s honing his speech on the imperative to “live in a moral, honest, just America.” A married former aide says he’s the father when she gets pregnant, even though she’s telling people Edwards is the dad. And one of his campaign donors pays off Hunter to get her resettled with the baby out of North Carolina.
But the Breck Girl wants a gold star for the fact that he sent his marriage into remission when his wife was in remission. That’s special.
In his statement, he bleats: “You cannot beat me up more than I have already beaten up myself. I have been stripped bare.” Isn’t stripping bare how he got into this mess?
It isn’t like we didn’t know that the son of a millworker was a little enraptured by himself, radiating self-love from his smile and his man-in-a-hurry airs and the notorious $800 bill for a pair of haircuts and his two-minute YouTube hair primping to the tune of “I Feel Pretty.”
Certain men assume that power confers sexual privilege. And in American politics, there is an eternal disjunction between character and achievement. Sinners do good things, saints do bad things.
Still, it’s bizarre the way these pols spend millions getting their faces plastered everywhere and then think they can do something in secret. “Yeah, I didn’t think anyone would ever know about it, I didn’t,” Edwards said.
In one of the Web films Hunter directed, he actually flirts with the blonde, laughingly telling her that his address on morality is “a great speech” and complaining, “Why don’t you hear me give it live?”
For some reason, super-strivers have a need to sell what is secretly weakest about themselves, as if they yearn for unmasking. Edwards’s decency and concern for the weak in society — except for his own wife. Bill Clinton’s intellect and love of community — except for his stupidity and destructiveness about Monica. Bush the Younger’s jocular, I’m-in-charge self-confidence — except for turning over his presidency, as no president ever has, to his Veep. Eliot Spitzer’s crusade for truth, justice and the American way — except at home.
In the Hunter video titled “Plane Truths,” Edwards is relaxing on his plane, telling the out-of-frame director: “I’ve come to the personal conclusion that I actually want the country to see who I am, who I really am, but I don’t know what the result of that will be. But for me personally, I’d rather be successful or unsuccessful based on who I really am, not based on some plastic Ken doll that you put up in front of audiences.” Ken couldn’t have said it better.
Back in 2002, Edwards sent me a Ken doll dressed in bathing trunks, Rio de Janeiro Ken, with a teasing note, because he didn’t like my reference to him as a Ken doll in a column.
In retrospect, the comparison was not fair — to Ken.
August 10, 2008
Op-Ed Columnist
Keeping It Rielle
By MAUREEN DOWD
WASHINGTON
John Edwards’s confession was a little bit breathtaking.
Not the sex stuff. That happens here all the time.
And certainly not covering up the sex stuff. That happens here all the time, too. First people uncover; then they cover up. Nobody’s ever had sex with that woman until, suddenly, they have.
The stunning admission Edwards made to ABC’s Bob Woodruff, and in a written statement from Chapel Hill on Friday afternoon, was that he’s a narcissist.
He admitted that wallowing in “self-focus” out on the trail and thinking you’re “special” can result in a solipsism that “leads you to believe you can do whatever you want, you’re invincible and there’ll be no consequences.”
Auto-psychoanalysis by the perp. That’s really rich. When Bill Clinton acknowledged an affair, after equally adamant denials, he simply went into an old-fashioned spiral of penitence, his allegedly long, dark night of his alleged soul.
Even in confessing to preening, Edwards was preening. His diagnosis of narcissism was weirdly narcissistic, or was it self-narcissistic? Given his diagnosis, I’m sure his H.M.O. would pay.
The creepiest part of his creepy confession was when he stressed to Woodruff that he cheated on Elizabeth in 2006 when her cancer was in remission. His infidelity was oncologically correct.
So narcissist walks into a New York bar and meets a legendarily wacky former Gotham party girl — whose ’80s exploits were chronicled in a novel by her former boyfriend Jay McInerney because the behavior of her and her friends “intrigued and appalled me.” When you appall Jay McInerney, you know you’re in trouble.
The president manqué gives Rielle Hunter, formerly Lisa Druck, more than $114,000 to shoot vain little videos for his Web site (even though she’s a neophyte), one of which is scored with the song “True Reflections” about the Narcissus pool, which goes: “When you look into a mirror, do you like what’s looking at you? Now that you’ve seen your true reflections, what on earth are you gonna do?”
He has an affair with Hunter, while he’s honing his speech on the imperative to “live in a moral, honest, just America.” A married former aide says he’s the father when she gets pregnant, even though she’s telling people Edwards is the dad. And one of his campaign donors pays off Hunter to get her resettled with the baby out of North Carolina.
But the Breck Girl wants a gold star for the fact that he sent his marriage into remission when his wife was in remission. That’s special.
In his statement, he bleats: “You cannot beat me up more than I have already beaten up myself. I have been stripped bare.” Isn’t stripping bare how he got into this mess?
It isn’t like we didn’t know that the son of a millworker was a little enraptured by himself, radiating self-love from his smile and his man-in-a-hurry airs and the notorious $800 bill for a pair of haircuts and his two-minute YouTube hair primping to the tune of “I Feel Pretty.”
Certain men assume that power confers sexual privilege. And in American politics, there is an eternal disjunction between character and achievement. Sinners do good things, saints do bad things.
Still, it’s bizarre the way these pols spend millions getting their faces plastered everywhere and then think they can do something in secret. “Yeah, I didn’t think anyone would ever know about it, I didn’t,” Edwards said.
In one of the Web films Hunter directed, he actually flirts with the blonde, laughingly telling her that his address on morality is “a great speech” and complaining, “Why don’t you hear me give it live?”
For some reason, super-strivers have a need to sell what is secretly weakest about themselves, as if they yearn for unmasking. Edwards’s decency and concern for the weak in society — except for his own wife. Bill Clinton’s intellect and love of community — except for his stupidity and destructiveness about Monica. Bush the Younger’s jocular, I’m-in-charge self-confidence — except for turning over his presidency, as no president ever has, to his Veep. Eliot Spitzer’s crusade for truth, justice and the American way — except at home.
In the Hunter video titled “Plane Truths,” Edwards is relaxing on his plane, telling the out-of-frame director: “I’ve come to the personal conclusion that I actually want the country to see who I am, who I really am, but I don’t know what the result of that will be. But for me personally, I’d rather be successful or unsuccessful based on who I really am, not based on some plastic Ken doll that you put up in front of audiences.” Ken couldn’t have said it better.
Back in 2002, Edwards sent me a Ken doll dressed in bathing trunks, Rio de Janeiro Ken, with a teasing note, because he didn’t like my reference to him as a Ken doll in a column.
In retrospect, the comparison was not fair — to Ken.
Thursday, August 07, 2008
August 7, 2008, 12:42 pm
Six Rules Doctors Need to Know
Tony Cenicola/The New York Times
Why are patients mad at doctors? Maybe, suggests medical blogger Dr. Robert Lamberts, it’s because doctors aren’t following the rules.
Doctors have always been a hot topic of discussion on the Well blog. We’ve talked about the rocky relationship between doctors and patients, a doctor’s disdain for medical Googlers, and whether doctors should lecture patients about their weight. And every time, hundreds of readers comment about how frustrated they are with doctors and the medical system.
Dr. Lamberts, an Augusta, Ga., physician and writer of Musings of a Distractible Mind, notes that he has a few simple rules that help him get along better with his patients.
Rule 1: They don’t want to be at your office.
It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.
Rule 2: They have a reason to be at your office.
They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.
Rule 3: They feel what they feel.
Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?
Rule 4: They don’t want to look stupid.
People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”
Rule 5: They pay for a plan.
What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.
Rule 6: The visit is about them.
With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.
To read the full column by Dr. Lamberts, who goes by Dr. Rob on his blog. He also promises a future post on rules patients need to know, so stay tuned.
Six Rules Doctors Need to Know
Tony Cenicola/The New York Times
Why are patients mad at doctors? Maybe, suggests medical blogger Dr. Robert Lamberts, it’s because doctors aren’t following the rules.
Doctors have always been a hot topic of discussion on the Well blog. We’ve talked about the rocky relationship between doctors and patients, a doctor’s disdain for medical Googlers, and whether doctors should lecture patients about their weight. And every time, hundreds of readers comment about how frustrated they are with doctors and the medical system.
Dr. Lamberts, an Augusta, Ga., physician and writer of Musings of a Distractible Mind, notes that he has a few simple rules that help him get along better with his patients.
Rule 1: They don’t want to be at your office.
It may seem odd to patients, but most doctors forget that going to the doctor is generally unnerving. We work there, and being in a doctor’s office is normal to us. Not so with most patients. The spotlight is on them and their health. They stand on the scale, undress, tell intimate things about their lives, confess errors, are poked, prodded, shot with needles, lectured at, and then billed for the whole thing….There is always an underlying fear and self-consciousness that pervades when a person is sitting on the exam table. The best thing to do in response to that is to show compassion.
Rule 2: They have a reason to be at your office.
They don’t come to the office to waste the doctor’s time. Yet early in my training I was incredulous at the reasons some of my patients were coming to see the doctor. Why come in for a headache? Why come in for a cold?…It took me being in my own practice (and trying to keep my business going) to realize that there is (almost) always an underlying reason for a patient to come in. Sometimes that reason is simple: they have terrible pain that needs to be treated. Other times, however, the reason is more subtle. When a person comes to my office with enlarged lymph nodes, for example, the real reason they are coming in is that they are afraid it is cancer. If a person has chest pains, they are afraid it is their heart. On every visit I try to identify the real reason (or the real fear) that brings them to see me. I don’t end the visit until I have addressed that reason.
Rule 3: They feel what they feel.
Patients will often tell me their symptoms in a very apologetic tone. They seem to think that they have to come to me with the “right” set of symptoms, and not having those symptoms is their fault. Sometimes those symptoms make no sense to me at all, and I am tempted to dismiss or ignore them. But as a physician, you have to trust your patient….Yes, some may exaggerate what they feel out of anxiety or out of fear that you won’t hear them for lesser symptoms, but then your job is to uncover the anxiety, not ignore the complaint. I have heard from many patients that their doctor “did not believe” their complaints because they did not make sense. If you don’t trust them, why should they trust you?
Rule 4: They don’t want to look stupid.
People are often worried that they are over-reacting. They wonder what I must think for a person to come to the office with that symptom. This is especially true of parents bringing their children in. Nobody wants to be “that mother that over-reacts to everything.” In response to this, I try to specifically say, “I am glad you came to the office for this because…” or “Yeah, I can see how that worried you because it could be….”
Rule 5: They pay for a plan.
What do people pay for when they come to the medical office? They pay for opinion, yes. They pay for knowledge as well. But what they really pay for is a plan of action….They want to know what is going to be done to help. I try and give a plan, either verbal or written, to each patient that walks out of the exam room. What medications are given and why? What medications are to be stopped? What tests are ordered and what will the results mean? When is the next appointment? What should they call for if they have problems? The better I can answer these questions, the more confidently the patient will walk out of the exam room. The days of paternalistic medicine are over - no handing a prescription and just saying “take it.” Patients should know why they are putting things in their body.
Rule 6: The visit is about them.
With all of the stresses in a doctor’s office, I get tempted to complain about things. Who better to complain to than someone who feels much the same way? But patients are paying for you to take care of their problems, not the reverse. I keep my personal gripes or frustrations to myself as much as possible.
To read the full column by Dr. Lamberts, who goes by Dr. Rob on his blog. He also promises a future post on rules patients need to know, so stay tuned.
Friday, August 01, 2008
Go after a man's weakness, and never, ever, threaten unless you're going to follow through, because if you don't, the next time you won't be taken seriously.
Roy M. Cohn (1927 - 1986)
Roy M. Cohn (1927 - 1986)
If you would convince a man that he does wrong, do right. But do not care to convince him. Men will believe what they see. Let them see.
Henry David Thoreau (1817 - 1862)
Henry David Thoreau (1817 - 1862)
I pack my trunk, embrace my friends, embark on the sea, and at last wake up in Naples, and there beside me is the Stern Fact, the Sad Self, unrelenting, identical, that I fled from.
Ralph Waldo Emerson (1803 - 1882)
Ralph Waldo Emerson (1803 - 1882)
Judith Warner
NYT
July 31, 2008, 6:26 pm
Camp Codependence
Tags: Parenting, sleep away camp
I’m sure we all read, with equal parts disgust and delectation, The Times’ story last week on affluent parents who just can’t let go when their children abandon them for sleep-away camp.
In case you missed it, the article presented fathers and mothers so used to instant service that they call camp directors at all hours of the day and night to sound the alarm if they suspect Junior isn’t using sunscreen. It showcased “high-end” sleep-away camps that employ full-time “parent liaisons” just to handle such phone calls and e-mail traffic, “almost like a hotel concierge listening to a client’s needs,” as a camp consultant put it.
One parent liaison explained that all her careful hand-holding can, when successful, make camp a learning experience for parents, too. The hope, she said, is that by the end, “They’ve learned how to separate a little bit better.”
The most enlightening part of the article for me was the most prominently featured camp’s reported cost: $10,000. Reading the price, I finally understood why, whenever I make mention of the fact that my elder daughter attends sleep-away camp, a few responders always comment upon how wealthy I must be.
For the record: my daughter’s sleep-away camp costs $550 a week.
Which, I now realize, is a good thing for reasons far beyond the family budget.
The $10,000-camp universe appears to be rife with what mental health professionals are now calling “affluenza,” a social pathology that, they say, is rampant at a time when getting and spending — a lot — have become our nation’s most cherished activities, and when purchasing power has become, to an unprecedented extent, almost the sole source of many people’s status and identity.
In our society, you don’t have to be wealthy to suffer from affluenza. Its symptoms — “debt, overwork, waste, and harm to the environment, leading to psychological disorders, alienation, and distress,” in adults; “lack of motivation … apathy, laziness, or failure to commit to and achieve goals … overindulgence and attitudes of entitlement” in children, according to the New York University Child Study Center (pdf), are pervasive — and no one is immune.
For affluenza is not just a constellation of symptoms. It is an ethic, a play-the-system, lie-and-cheat-your-way-to-what-you-want, don’t-let-the-peons-stand-in-your-way ethic of amorality. You rock, kid, parents teach. And you — alone — rule.
This ethic drives behavior — like the behavior of the wealthy parents profiled in The Times who, flouting camp bans on cellphone use, sent their kids off with two phones, so that, if one was confiscated, there’d still be a spare for secret calls home. And it also permeates social attitudes and policy.
Yet if affluenza, in greater or lesser form, has infected wide swaths of the population at large, one group — the children of the rich — appears to be particularly susceptible to its ravages.
Many studies have shown positive trends among American teenagers in recent decades regarding problems like teen suicide, pregnancy, substance use and violence. Yet upper middle class kids appear to be floundering, outpacing their peers in rates of cigarette smoking, depression, alcohol and drug abuse, anxiety, rule-breaking, and psychosomatic disorders like headaches and stomach problems, writes Madeline Levine, a clinical psychologist in California’s wealthy Marin County, in her 2006 book, “The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids.”
Sociologist Annette Lareau, who studied the childrearing habits of middle-, upper-middle- and working-class families in depth for her 2003 book, “Unequal Childhoods: Class, Race and Family Life,” has found that working class children, who have fewer scheduled activities, more unstructured time and less fussing-over generally by adults, are more spontaneous and creative in their play than are middle- and upper-middle-class kids, enjoy their leisure activities more, and show greater autonomy and self-reliance.
“Indulged children are often less able to cope with stress,” writes Harvard psychologist Dan Kindlon in his book, “Too Much of a Good Thing: Raising Children of Character in an Indulgent Age,” “because their parents have created an atmosphere where their whims are indulged, where they were always assured … that they’re entitled and that life should be a bed of roses.”
In the case of the rich children at the sorts of fancy camps featured in the paper last weekend, it’s easy to point fingers at signs of incipient pathology. All that parental micromanaging is sure to suppress problem-solving, one could say. Unconstrained parental meddling is bound to kill off kids’ resilience.
“If your child doesn’t get the bunk they want or you’re worried that he didn’t get the right camp counselor, if you convey that kind of response — ‘Oh my God, that’s awful, let me call them, it’s so unfair’ — that’s the worst possible response a parent could have,” Catherine Steiner-Adair, a clinical psychologist who consults with camps, told The Times’ Tina Kelley.
I wonder what that psychologist would make of a camp I heard tell of this summer, which permits campers to regularly make phone calls home and scripts parents on what to say, and which requests that parents ship their children’s belongings weeks in advance, so that staffers can unpack them, make the campers’ beds, and have things sufficiently home-like before the children arrive.
It’s easy to imagine that all this pampering will lead to irreversible mental damage. But, the problem is: I don’t quite buy it. The vast majority of these wealthy and pampered kids, so long as they’re bolstered by hardy genes and have parents whose foibles don’t run to extremes, will ultimately be just fine. They’ll thrive, in fact, in the society of their parents’ making.
(In Lareau’s research, middle- and upper-middle-class kids — however dependent, demanding, lacking in initiative and quick to get bored — were much more successful in school than were the working-class children in part because their privileged upbringings gave them a sense of entitlement that allowed them to navigate adult institutions with ease and aplomb.)
My worry is for the rest of us. For the parents who try to teach our children to play by the rules (obey your counselors; make your bed). And for our children, who are likely to come out the losers in a society dominated by sharks.
I actually have some sympathy for the parents whose strivings and fears have built the culture I find so dangerous and distasteful. I know that their actions, at root, spring from love and that their behaviors — however obnoxious — often arise from ill-considered attempts to save their children from pain.
I feel much greater resentment toward the institutions — like the camps that permit way too much parental presence and schools that encourage way too much parental involvement — which enable the worst parent behaviors, comfort their worst tendencies and cater to their basest fears, all, very often, in the interest of making an extra buck.
The buck has to stop somewhere. It’s clearly not going to be stopped by this generation of befuddled parents. It’s time that the professionals we entrust with our children stopped catering to their “clients” and started treating them like grown-ups.
NYT
July 31, 2008, 6:26 pm
Camp Codependence
Tags: Parenting, sleep away camp
I’m sure we all read, with equal parts disgust and delectation, The Times’ story last week on affluent parents who just can’t let go when their children abandon them for sleep-away camp.
In case you missed it, the article presented fathers and mothers so used to instant service that they call camp directors at all hours of the day and night to sound the alarm if they suspect Junior isn’t using sunscreen. It showcased “high-end” sleep-away camps that employ full-time “parent liaisons” just to handle such phone calls and e-mail traffic, “almost like a hotel concierge listening to a client’s needs,” as a camp consultant put it.
One parent liaison explained that all her careful hand-holding can, when successful, make camp a learning experience for parents, too. The hope, she said, is that by the end, “They’ve learned how to separate a little bit better.”
The most enlightening part of the article for me was the most prominently featured camp’s reported cost: $10,000. Reading the price, I finally understood why, whenever I make mention of the fact that my elder daughter attends sleep-away camp, a few responders always comment upon how wealthy I must be.
For the record: my daughter’s sleep-away camp costs $550 a week.
Which, I now realize, is a good thing for reasons far beyond the family budget.
The $10,000-camp universe appears to be rife with what mental health professionals are now calling “affluenza,” a social pathology that, they say, is rampant at a time when getting and spending — a lot — have become our nation’s most cherished activities, and when purchasing power has become, to an unprecedented extent, almost the sole source of many people’s status and identity.
In our society, you don’t have to be wealthy to suffer from affluenza. Its symptoms — “debt, overwork, waste, and harm to the environment, leading to psychological disorders, alienation, and distress,” in adults; “lack of motivation … apathy, laziness, or failure to commit to and achieve goals … overindulgence and attitudes of entitlement” in children, according to the New York University Child Study Center (pdf), are pervasive — and no one is immune.
For affluenza is not just a constellation of symptoms. It is an ethic, a play-the-system, lie-and-cheat-your-way-to-what-you-want, don’t-let-the-peons-stand-in-your-way ethic of amorality. You rock, kid, parents teach. And you — alone — rule.
This ethic drives behavior — like the behavior of the wealthy parents profiled in The Times who, flouting camp bans on cellphone use, sent their kids off with two phones, so that, if one was confiscated, there’d still be a spare for secret calls home. And it also permeates social attitudes and policy.
Yet if affluenza, in greater or lesser form, has infected wide swaths of the population at large, one group — the children of the rich — appears to be particularly susceptible to its ravages.
Many studies have shown positive trends among American teenagers in recent decades regarding problems like teen suicide, pregnancy, substance use and violence. Yet upper middle class kids appear to be floundering, outpacing their peers in rates of cigarette smoking, depression, alcohol and drug abuse, anxiety, rule-breaking, and psychosomatic disorders like headaches and stomach problems, writes Madeline Levine, a clinical psychologist in California’s wealthy Marin County, in her 2006 book, “The Price of Privilege: How Parental Pressure and Material Advantage Are Creating a Generation of Disconnected and Unhappy Kids.”
Sociologist Annette Lareau, who studied the childrearing habits of middle-, upper-middle- and working-class families in depth for her 2003 book, “Unequal Childhoods: Class, Race and Family Life,” has found that working class children, who have fewer scheduled activities, more unstructured time and less fussing-over generally by adults, are more spontaneous and creative in their play than are middle- and upper-middle-class kids, enjoy their leisure activities more, and show greater autonomy and self-reliance.
“Indulged children are often less able to cope with stress,” writes Harvard psychologist Dan Kindlon in his book, “Too Much of a Good Thing: Raising Children of Character in an Indulgent Age,” “because their parents have created an atmosphere where their whims are indulged, where they were always assured … that they’re entitled and that life should be a bed of roses.”
In the case of the rich children at the sorts of fancy camps featured in the paper last weekend, it’s easy to point fingers at signs of incipient pathology. All that parental micromanaging is sure to suppress problem-solving, one could say. Unconstrained parental meddling is bound to kill off kids’ resilience.
“If your child doesn’t get the bunk they want or you’re worried that he didn’t get the right camp counselor, if you convey that kind of response — ‘Oh my God, that’s awful, let me call them, it’s so unfair’ — that’s the worst possible response a parent could have,” Catherine Steiner-Adair, a clinical psychologist who consults with camps, told The Times’ Tina Kelley.
I wonder what that psychologist would make of a camp I heard tell of this summer, which permits campers to regularly make phone calls home and scripts parents on what to say, and which requests that parents ship their children’s belongings weeks in advance, so that staffers can unpack them, make the campers’ beds, and have things sufficiently home-like before the children arrive.
It’s easy to imagine that all this pampering will lead to irreversible mental damage. But, the problem is: I don’t quite buy it. The vast majority of these wealthy and pampered kids, so long as they’re bolstered by hardy genes and have parents whose foibles don’t run to extremes, will ultimately be just fine. They’ll thrive, in fact, in the society of their parents’ making.
(In Lareau’s research, middle- and upper-middle-class kids — however dependent, demanding, lacking in initiative and quick to get bored — were much more successful in school than were the working-class children in part because their privileged upbringings gave them a sense of entitlement that allowed them to navigate adult institutions with ease and aplomb.)
My worry is for the rest of us. For the parents who try to teach our children to play by the rules (obey your counselors; make your bed). And for our children, who are likely to come out the losers in a society dominated by sharks.
I actually have some sympathy for the parents whose strivings and fears have built the culture I find so dangerous and distasteful. I know that their actions, at root, spring from love and that their behaviors — however obnoxious — often arise from ill-considered attempts to save their children from pain.
I feel much greater resentment toward the institutions — like the camps that permit way too much parental presence and schools that encourage way too much parental involvement — which enable the worst parent behaviors, comfort their worst tendencies and cater to their basest fears, all, very often, in the interest of making an extra buck.
The buck has to stop somewhere. It’s clearly not going to be stopped by this generation of befuddled parents. It’s time that the professionals we entrust with our children stopped catering to their “clients” and started treating them like grown-ups.
