Friday, September 26, 2014

Pediatrics and the NFL


So much starts at the beginning. As a pediatrician I'm used to looking at the long curve of life, and trying to help people adjust that curve for their kids at the beginning. We promote physical health – exercise! – and we prevent physical disease – immunize! But beyond the body, we try to promote and prevent with behaviors as well as physical health.

So as a pediatrician, I looked at the recent NFL problems of personnel misbehavior off the field with a weary familiarity. Yes, athletes tend to be spoiled by adulation and indulgence by organizations that hope to benefit from their skills. Yes, their sport is violent. But no, these are not just “dumb athletes.” They are people of good intelligence and character who just didn't get the early training – and pediatric guidance – that they should have.

I looked at the Ray Rice video and cringed along with everyone else. It was clear that Janay was coming at him – she had a lot to say, and it didn't look complimentary. She appeared pretty verbal even in a silent video. I saw Ray's bottled up fury. What could he do? I wanted to yell out to him: “Ray, use your words!”

I know that sounds all touchy-feely and nerdy, and to some ears it sounds unmasculine. Women talk and talk and we men drink beer with each other and grunt and laugh, right? Well, no, not right. Women might be naturally more verbal on average, at least in our society, but men can and should learn to use language instead of physical strength. This can be learned! It needs to be learned.

Parents teach kids to use words instead of fists. Even if the parents themselves lack the verbal and personal skills needed, they can send the kids to preschools to learn to use their words. My own children got a full dose of using words at a preschool that was decidely unacademic, but instead stressed social skills and talking with one another, and conflict avoiding strategies. If Ray Rice had been my kids' classmate, he would have had his teacher's voice in his mind. He would have heard her saying, “Ray, use your words!” And he would have had those words to use right there in his mind.

Then we got the grim news about Adrian Peterson, that wonderful running back whom I had always thought a fine man. My God, hitting his four year old with a tree branch? And then Charles Barkley saying that that's just the way of the South? Did your families never go to a pediatrician? Did you never hear about not hitting children, and in fact not hitting anyone? Hitting with a switch? My pediatrician (OK, also Northern and Jewish) mind just boggles.

Gentlemen, hitting begets hitting. Hit a kid and he will kick a dog, and when he gets older, he will in turn hit a kid and who knows whom else. Do you think fear of bodily harm is what keeps people in line? I'm not advocating guilt and shame, understand, but there are other things that work. Most people turn out like their parents, so setting an excellent example is the most important job of parenting. Discipline can be exacted by direction and attention and by setting proper incentives. The most important of all is positive reinforcement. Catch your kid doing something good, and praise him! Show him. Set expectations, set up consequences of bad behavior that withdraws privileges, give him a time out if you want. There are lots of things to do. But Adrian, and Charles, please, hitting is not the right way.

As pediatricians we try to get things right at the start, to set the curve of life in a positive direction. We try to direct our parents and their kids to positive interactions, to positive child rearing, to verbal self defense and explanation. Maybe it seems wimpy, maybe it does. But maybe some wimpiness is just what the doctor ordered. It sure beats cold cocking the girl you're going to marry.

Budd Shenkin

Tuesday, September 23, 2014

A Well Child Physical for Two Sisters


I had two little girls for check ups, ages 3 and 6, and their efficient-appearing mother. When sibs appear like this I generally do “double physicals” – that is, sisters together. That's always a nice thing to do, do it together. You can cover the things that apply to both, you can take a topic and make one comment for age 3 and another for age 6.  This is the way a mother thinks, anyway: column A for one and column B for the sister.  You can compare and contrast.  You can watch how the family interacts. It's a nice family thing.

So I didn't hurry; I felt like doing a really good job. They were nice little girls.  The 6 year old maybe wants to be a doctor, so I showed her how to wash her hands before you see your patients. I talked to them quietly and with some humor, as is my wont. I had them jump together. I asked the 6 year old to show the 3 year old how to hop, which she did quite well. I did some developmental queries, which were normal. I asked them both if they pooped every day, and if they had belly aches – they did, and they didn't. We looked at the growth charts, which were normal.

I imparted wisdom. I told the mother how we can say all we want to, but most of our children's behavior will mirror our own. If we are nice to people, they will be, too; if we are mean, so will they be. In the end, our knowledge of our impact on our children is a prime motive force for us to clean up our own act.

I asked them if they could swim – a prime safety concern. They can't yet. The mother can, however, which is good. I sympathized how it is hard to mobilize to get to a pool, lessons, etc., but opined that it was worth doing, and why. I asked about physical activity, which they get a lot of. I asked about screen time, which is limited in their house.

The mother objected when I tactfully examined the 6 year old's pubis while she lay down, saying she didn't want males to look there with her kids, and she didn't know why she had been assigned a male doctor. I told her that I get a little edgy examining the older girls myself, and usually urge them to switch to a female sometime after 11 years old. But while it's important to be careful – Uncle Phil might not be a safe babysitter – here we were with a doctor and being chaperoned by her, the mother. I thought it would be important for the girls to be able to feel safe with a trusted male, for their own future benefit. I hoped the point got across.

I took my time with the visit, not rushing, although you can never cover everything. I felt that I was really doing a good job with them. And then I said, “Is there anything else you would like to talk about?”

To my surprise, the mother responded, “Actually, I didn't know it would all take so much time. I thought I would just get the form signed and get out of here. Are you done?”

“Yes,” I said, “sure. I do think it's important for you to feel that you have a trusted source of care to come to here at Bayside.” In other words, there is something at stake in making a personal connection here.

And she said, “I do.”

“And I hope that the girls feel secure with their source of health care also.”

“Yes, they do,” she said.

So that was it. Kinda funny. There are forms people need filled out, and we take advantage of that obligatory visit to foist good health care upon them. Who knows, maybe I did some good. Who knows?

Budd Shenkin

Tuesday, September 16, 2014

On the impertinence of others


My lifelong friend is Bob Levin.  He always says that when we were young we didn't like each other. I always answer, Well, I liked you.  He is actually a sweetheart.

Today Bob has written in his new blog about his adventures in local establishments trying to stand up for order, as others push themselves forward in competition over very little.   Check it out at http://www.theboblevin.com/?p=245.

I have had my own difficulties with the trespasses of others. I have always thought that saving a place - like, coming down at 7 AM and plopping your bags onto a couple of poolside lounges that you will then occupy physically from 10 AM to 11 AM and 2 PM to 3 PM, was typical New York (or LA) behavior, and that resorts should be forced to post, much as McDonald's has to post calories, a New Yorker Quotient, so we could avoid high NYQ hotels.

My belief in this thesis, I believe, conforms also to my seeking to identify gender and ethnicity of the latest terrible driver, driving 50 MPH in the left lane so it's all clear ahead and people driving a normal speed have to pass on the right.
It seems, however, that the NYQ and the bad-driver identification do not provide usable results.  The reserve a seat behavior spreads to all groups because it works, since most hotels don't enforce a limit -- some do, and good for them!  Likewise, police enforce mostly a speed limit rather than competence and courtesy.
So there you are.  I believe this lack of enforcement is lamentable and anti-social.   By the broken windows thesis, it's a short step from these misdemeanors to ISIS. 

Such a world!

budd shenkin

Thursday, September 4, 2014

Racial Makeup of Police Departments -- Check Out Berkeley

The Ferguson, Missouri problem has located an underlying problem of American society that many of us whites were not well aware of.  Police departments are predominantly white, and are not changing in step with the demographic changes of the country. 

I see this as a problem with two dimensions: employment and authority.  Immigrants cluster in specific places according to their homelands -- you go to where you have friends and family who paved the way, so that, for instance, Ethiopian communities are strong in Washington, D.C., Seattle, and Oakland, and Jews came to the Lower East Side.  Employment patterns are similar -- Merrill Lynch, for instance, was well known as the Irish financial institution.  So police departments recruit the familiar as well -- whites (but I don't know why they all appear to be so beefy).  Especially in days of an employment squeeze such as we now have, these corridors to employment will be especially prized and difficult for outsiders to penetrate.

But there is also the authority dimension.  Official America and moneyed America is still pretty white.  Keeping the "other" in their place is still the role of law enforcement.  Official America is thus very happy with a white police force.  It seems that police forces act in the expected way, with covert racial profiling hassling the "other."  I'm not sure I accept all the statistics about who gets stopped, since minority populations are generally poorer and possibly less inclined to follow the law and thus more liable to be the subject of a righteous stop.  On the other hand, the accounts of black men being pulled over many times and having to keep their cool are very convincing.  Very.  So the authority function of white cops keeping minorities in subjugation seems pretty obvious.

I hadn't focused on all this well because I am looking to relax, to say that things are much better than they used to be.  But Ferguson has helped me see that I was just being lazy.  In fact, there is so much racism in our country, and it is so unfair, that it makes me depressed to think about.  OTOH, I am more and more satisfied that I insisted that our practice, Bayside Medical Group, serve all groups equally and with respect, taking Medi-Cal patients unlimitedly.  At least to a certain extent, we were part of the solution and not part of the problem.  I remember that one of my patients said about me, "Dr. Shenkin is a good doctor!"  By emphasizing the word "good," she divided the profession into two, and if you were "good," it meant you were someone who cared and gave patients respect.  I'm hoping not all of that goes down the drain now that I have sold Bayside.

My wife and I often ridicule the city of Berkeley, where we have chosen to live.  There are so many idiots, and so much trendy crap, and so much PC.  But we choose to live here.  And here below is one of the reasons why.  In today's NYT there is a wonderful article that exhibits the racial statistics of police departs throughout the country.  It's generally pretty dreadful.  But here in Berkeley the PC influence has actually worked.  It makes me happy and proud.  And sad to see the rest of the Bay Area lagging behind, perhaps more in tune with the rest of the country than with us.  The statistic "+__%" in the list below describes how much more the police force is white than is the community they serve.

Budd Shenkin


San Francisco
Minorities make up more than half of suburban San Francisco towns like Daly City, Hayward and Fremont, but their police departments are heavily white. Berkeley has more black officers than white, and the share of white officers in the department is on par with the share of whites in the city.
San Francisco
Department
WHITE
BLACK
HISP.
ASIAN
OTHER

Daly City, Calif.
Pop. 101,123
108 police officers
Residents
Police
Police Dept.
+52 pct.
pts.
more white
than residents
Hayward, Calif.
Pop. 144,186
191 police officers
Residents
Police
+50 pct.
pts.
more white
Fremont, Calif.
Pop. 214,089
185 police officers
Residents
Police
+48 pct.
pts.
more white
San Bruno, Calif.
Pop. 41,114
48 police officers
Residents
Police
+47 pct.
pts.
more white
San Mateo, Calif.
Pop. 97,207
114 police officers
Residents
Police
+45 pct.
pts.
more white
Sunnyvale, Calif.
Pop. 140,081
207 police officers
Residents
Police
+36 pct.
pts.
more white
Santa Clara, Calif.
Pop. 116,468
137 police officers
Residents
Police
+34 pct.
pts.
more white
Redwood City, Calif.
Pop. 76,815
91 police officers
Residents
Police
+33 pct.
pts.
more white
San Jose, Calif.
Pop. 945,942
1,386 police officers
Residents
Police
+31 pct.
pts.
more white
Richmond, Calif.
Pop. 103,701
161 police officers
Residents
Police
+31 pct.
pts.
more white
San Rafael, Calif.
Pop. 57,713
73 police officers
Residents
Police
+26 pct.
pts.
more white
Albany, Calif.
Pop. 18,539
27 police officers
Residents
Police
+25 pct.
pts.
more white
Alameda, Calif.
Pop. 73,812
99 police officers
Residents
Police
+23 pct.
pts.
more white
Oakland, Calif.
Pop. 390,724
725 police officers
Residents
Police
+18 pct.
pts.
more white
El Cerrito, Calif.
Pop. 23,549
42 police officers
Residents
Police
+18 pct.
pts.
more white
San Francisco, Calif.
Pop. 805,235
2,303 police officers
Residents
Police
+12 pct.
pts.
more white
Palo Alto, Calif.
Pop. 64,403
87 police officers
Residents
Police
+9 pct.
pts.
more white
Berkeley, Calif.
Pop. 112,580
181 police officers
Residents
Police
+1 pct.
pts.
more white