My last hospital day shift was Thursday. This morning I completed my first of six night shifts of my last ever night float. In less than a week I'll be done with hospital medicine entirely. Very much looking forward to it.

I Have a Job!

I'm now realizing that this little medblr has been severely neglected during residency, but I'd rather neglect a blog than my mental health I guess. But hey I have a job! I'll be working at a private practice starting in September, doing family medicine (including pediatrics and gynecology), procedures, osteopathic medicine, and gender affirming care. I think it's a good fit for me and I like the idea of a salary rather than RVU based payment. I don't ever want to slip into thinking of my patients as money.

I Passed My Boards

It's a preliminary result but still feels good. Now I'm starting to apply for my full license which is hella daunting but I'm making headway. I'm currently on my last vacation in residency. Then I'm in the hospital for the next three weeks, two weeks of days and a week of nights. But then it's June and I'm just in the clinic until residency finally FINALLY ends!!

I just started a patient on HRT for the first time ever in our residency clinic!!

After ~2.5 years of residency, 1.5 years of building a LGBTQIA+ curriculum, 4 months of advocacy seminars, and a whole lot of barriers, we have finally gotten the okay to start initiating hormone therapy for the purpose of gender affirming care.

This patient is one of two who I had already started the evaluation and informed consent process. We had actually already decided on a plan to start estrogen, but this week the administration approved our official informed consent form so she came in, signed it with my colleague, and got to start estrogen tonight!!

This is a huge milestone for our clinic, residency, and community but also for me, my colleague (who has been a huge champion for all of this change), and of course my patient. I'm honestly a little bummed that I wasn't the one in clinic today to have the visit after doing all the evaluation and informed consent, but the excitement and progress is definitely worth it and I'm thankful for that.

Which intervention level (individual, interpersonal, organizational, systemic) resonates most with you? Describe an action step you intend to take to advance sexual and gender minority (SGM) health equity at this intervention level.

I have always been most fulfilled by making changes at the interpersonal level. Individual changes are probably the easiest to complete but don't have that same sense of fulfillment and organizational/systemic changes are often a bit too daunting and I become easily overwhelmed with so many changes needed.

I have already made some significant interpersonal interventions since co-creating a LGBTQIA+ family medicine curriculum. The one intervention that really left an impact was just openly discussing the community and their needs with a co-resident who was very hesitant about caring for this community and listening to the bad experiences she had had with a member of the community in the past. She felt heard and was then open to taking in more information and learned that several of her colleagues also belong to the community. I watched her become more engaged through further lectures and start to relate the SGM health issues to issues she has faced as a racial minority. She then graduated and went on to provide care for minorities of all types in Missouri, somewhere that desperately needs open minded people like the amazing doctor that I watched her become.

My next interpersonal action step is to teach our new interns about LGBTQIA+ competent care. They are all so excited to learn how to best treat all of their patients. Unfortunately, it is up in the air as to whether our residency will allow me to continue giving regular formal lectures on this topic as there has been a lot of push back from a few opposing individuals. Regardless, me and my colleague who developed the curriculum are seen as experts in this field of medicine, especially gender affirming care, and the interns have already started bringing all of their questions about that to us. While I have quite a ways to go before I consider myself an expert, I do have a lot of knowledge and resources at my disposal and I look forward to teaching them how to best treat all of their patients regardless of my ability to have formal lectures.

What happens when I don't finish my notes in clinic?

I usually try to finish my notes the same day, but sometimes mental health demands a rest. So here's a time lapse of me doing clinic notes on a sleepy Sunday morning ☕

Thank goodness for phone dictation apps.

How would you explain minority stress and minority resilience?

Before we discuss minority stress and resilience, we need to define allostatic load. My osteopathic medical school taught us about allostatic load before we learned anything else, so for me it is an integral part of medicine, but during this seminar I learned that not every medical school teaches this. Allostatic load is the sum of all the stressors that are affecting a patient, be that medical (hypertension/diabetes/flu/etc), psychological (depression/anxiety/schizophrenia/etc), familial (mom is sick/brother being deported/dad disapproves of you/etc), osteopathic (vertebrae out of alignment/rotated sacrum/stuck rib/etc), social (speaking only Spanish in an English speaking country/not having insurance/isolation from community/etc), or anything else that can affect the patient.

That makes sense, right? The more the patient has going on at baseline, the less reserve they have to deal with a new issue. So someone with a high allostatic load will be more affected by the same thing as someone with a low allostatic load.

Minorities by definition will then have a higher allostatic load than someone who is not a minority. So things that may not be catastrophic or overwhelming to a non-minority may be for a minority member. That is minority stress.

Minority resilience on the other hand, is when people can draw strength and community through their identity. A great example of this in sexual and gender minorities is pride month! Lots of people feeling joy and community being their true selves.

While minority stress is a good model to explain why minority individuals have higher rates of health issues and stress in general, it can also be weaponized against minorities in the media. For example, if queer folks have higher rates of depression, bigots may advocate for more conversion therapy because if they're no longer queer, they won't have depression. However in reality this is counterintuitive because it is not them being queer that is making them depressed but rather the stigma that our society places on them and the inequality that they face that contributes to the depression. If being straight was the minority, then straight folks would have higher rates of depression. It's not the identity, it's the societal repercussions.

Hi friends! It's been a while... Or is two years more than a while?

Anyway, I've continued to not only survive residency but also grow as a person and physician. Over the past two years, I have found my niche in family medicine moreso than just my OMT and behavioral health focus (which are both still going strong by the way). I have become one of the only providers of gender affirming care in my area and a fierce advocate for the LGBTQIA+ community.

Because of this, I have started to further my learning through a year-long LGBTQIA+ health fellowship seminar series. This program has requested I post a reflection on a blog after each seminar, and since I already have a blog, I figured why not post here and spread the knowledge to the medblr community.

Anyway, I just wanted to make an intro post explaining the posts to come so it's less weird when I start posting very specific/niche blog posts. As I stated before, I am a fierce advocate for the LGBTQIA+ community and I will literally just be posting my homework, so any anti-LGBTQIA+ comments will be deleted and the user will be blocked. I don't have time to debate strangers on the internet as to why human beings should be allowed to exist.

Yesterday I delivered a baby and ran a rapid where we let a DNR/DNI patient pass peacefully in the same inpatient shift. There is no other specialty in the hospital capable of doing that. Family Medicine is truly cradle to grave and it takes a special kind of person to do it.

The worst kind of 12 day work week is the one you don't know is a 12 day work week until day 6 when you wake up on your "day off" to your team calling you asking were you are because there was a last minute schedule change

Oh boy I'm back! I had a nice long weekend after my week of nights and spent this week in the clinic. Yesterday we had a "resident retreat" which is a biannual wellness event. Since I'm one of the Wellness Coordinators for our residency, we got to make the "educational team building activities" a series of crazy escape rooms followed by a "social lunch" at a nearby brewery!

Next week I'm on palliative care which should be a nice change of pace from the hectics of the hospital.

Ya girl just finished night 2/5 on day 7/10

I feel like I'm actually learning a lot on nights. There's no attending who I can ask questions to, I have a backup senior who checks my orders since this is my first time on night float, but the idea is to use them as little as possible so I can get comfortable for next time when I'm on alone. So I have to figure out everything I do and make sure that it's the right thing to do in that situation. And honestly that's how I learn best.

Still looking forward to sleeping at night again though lol

I did it

I finished my first 12 day work week

Excuse me while I sleep

Sounds gross but I had an awesome day. I'm on my family medicine elective rotation which means I spent the first half of the week seeing my patients in my clinic and the second half of the week at another primary care clinic in the next town over seeing their patients.

They do lots of procedures in their clinic including circumcisions since they manage all their patients births in the hospital as well. Today I was in on so many that I was basically doing them by myself at the end of the day. It makes me laugh that the first time I saw a clinical procedure (suturing a laceration) in undergrad, I almost fainted but now I actually really enjoy them since it's such a tangible accomplishment during a visit.

First day on inpatient service

Today I saw patients with an NP in the morning and spent the afternoon seeing patients with an attending who also happens to be my faculty mentor and an expert in OMT. We did a lot of OMT today, even on patients who weren't originally there for it! Since he has a full patient panel and is going on vacation soon, all those patients who now want more OMT visits are scheduling with me and it's blowing my freaking mind to not only be seen as a doctor but that people actively want me to be THEIR doctor. Like what? And I get to continue seeing them regularly for the next three years? Maybe more? Whattttttt

I want a girl who gets up early

I want a girl who stays up late

I want a girl with a short skirt and a longgggggg white coat

Short Skirt/Long Jacket -Cake

All jokes aside, I finally saw patients as a doctor today!! It just kinda felt like med school since all my patients were co-visits with a senior resident. I had to advocate for myself a bit to be introduced as Dr. Justine'sLastName instead of Justine the intern, but once it became clear to patients that I wasn't actually a med student everything else went very smoothly. And now I have the weekend off!!