The Making of My MD/MBA

Dear Blog,

 “Adult Ed is a Mother, but it’s also a Keeper!”… Dr. Lulu

Last Friday as I found myself finishing up the last day of the last week of my 27-month journey into the land of a Masters in Business Administration at UTSA, my heart was a mixture of all sorts of emotions, the strongest of which was joy! Since I couldn’t keep it to myself, I did an impromptu FB Live and literarily broke into song and dance on screen! I no longer have to stay up late studying and doing homework EVERY NIGHT. I can now stop using “school” as my excuse for everything (I really don’t want to do). I get to add those coveted three letters to the other two after my name. I can now get much-needed rest (umm, say what?) Let me rephrase that, I shall try going to bed at 11pm every night (yeah right!) I finally, realize my dream of walking on an American stage wearing the black gown and black “crown”, and as an added treat, I get to wear VA cords!

In September of 2016, my 4yr term as a Lt Col. in the United States AirForce came to an end. In deciding what to do next, I realized I had multiple options to pick from; join the Air Force Reserves, go back to school and get a Masters Degree, or get a regular job as a pediatrician. I decided to go for the last two options. And no, I had no specific “why”, I simply wanted to use the VA educational funds I was entitled to, it was more like a “why not?”. The decision was met with a combination of gasps, shock, surprise and some reluctant encouragement from friends and family. Never one to waste too much time chewing on a thought, I jumped in with two feet (before I lost my nerve) Coincidentally, my first son was about to go into college at the same time and my spouse had also decided to get her Masters degree as well…so, I was in good, no, great company! (That sh** just about cost us our union, but that’s another day’s blog, LOL)

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Later that month, as I was walking out of my job interview at Communicare Health Centers, I remember wondering to myself how I would manage a full-time work schedule and a full-time school schedule. I had initially wanted to do the combined MPH/MBA program, but FEAR and its close friend DOUBT, proceeded to discourage me and talk me out of it, so I settled for just the MBA. I was as excited as I was anxious! My colleagues, (after getting over the initial disbelief) quickly got on board and started cheering me on. I still had no idea how I was going to “manage” it, but I put my best Naija Igbo Woman foot forward (as per we no de eva carray last) and started the regular MBA at UTSA. Not online, in person, albeit, nearly 30 years post graduation from medical school, owning my own private practice for nearly 15 of those years and doing a brief 4yr stint as a Lt. Col in the US Air Force! I was going about mine backwards.

The first semester went like a breeze (or did it?) I now only remember that I had a hard time getting used to not only going back to school but also going back to school in the tech age! Just like my initial shock when I first came to the USA which I shared here in this earlier blog, going back to school, in America, was FULL of new experiences…!

Crocs store-1.jpgFirst off, I was one of, if not the oldest student in that regular MBA class! I was not happy about that at all. I hated the fact that I was in class with late teens and early twenty-something-year-olds. Their mannerisms were a total lack, they were disrespectful, noisy, lackadaisical, and sometimes rude to the professors(s). What struck me the most was their tendency to not do the work! They were very content with not showing up for class, joining in class discussions or even doing their portion of the school work at all… (I guess I am seriously old school) This bothered me so much that after that first semester, I went back to my student adviser and requested to disenroll. Luckily, she was kind enough to understand my position and suggested I sign up for the Executive MBA program instead. I was really lucky because I literally made the interview on the last day! Reminds me of a similar incident with Howard University Hospital Residency interview, I also talked about here. Thankfully, I got in! Since my paperwork was already in the school of business, all I needed was an intradepartmental transfer. She hit the jackpot with that suggestion because once I understood what an Executive MBA was, I TOTALLY LOVED the idea! However, a couple of my “friends” queried the “executiveness” of it all…”make sure it is not a watered down version of an MBA”, is it an E-MBA as in online/electronic? “are you going to have a real MBA degree when you get done?” and, “why de heck are you even going back to school, aren’t you tired?” Hmmm…how does one respond to all that love?IMG_0818

At the Executive MBA program, my cohort comprised of people closer to my age, adults. managers, business owners, entrepreneurs, vice presidents, CEOs, executives, parents, grandparents, wives, and husbands. A fair number of them were still younger than me, but the age gap was not nearly as much. The youngest in my class was 31 yrs old. They had all seen life and lived it a little. A lot of them were well-traveled. They were much more experienced and for the most part, wanted to do their school work. My kind of people. We were different, yet the same. A few were veterans like me, a few were foreigners like me, a few were mothers of kids in college like me, a few were divorced like me, and one was not only the other one Black person, he is also Nigerian like me! Awon Naija sha! I believe I lucked out!

In spite of all that, the school work was still a huge challenge for me. I had to get used to school the American way. Folks actually call their professors by their first names around here, huh? Not in Nigeria, tufiakwa! I went to medical school in the 80s, graduated in the very early 90s. We had real chalkboards, not smartboards. Our blackboards were not virtual, they were really black and physically present in the classroom. I had no concept of the word office-hours, luckily, my son who was then a freshman at Stanford University explained what that meant to me. I had no idea what it meant to access library books online, and be able to “check them out” virtually? What de? As shocking as these findings were to me, there was more to come.

IMG_0841As the only physician and one of 2 Blacks of the lot, 33 of us to be exact, I had no one else wearing my exact shoes, hmmmm. I had no one to hold on to when Statistics got tough (yea, I know, I did biostatistics in med school, so I recalled sensitivity and specificity, but certainly not Anova or Covariance Analysis) I had no one to hold on to when Accounting reared its ugly head, or when Finance got crazy (my poor mom, a retired accountant, who was visiting at that time, got a daily dose of complaints from me). As a self-proclaimed hater of numbers (except those on my paycheck and bank account) I loathe Excel…still do! First of all, I had never really heard about it, furthermore, I not only had to learn its basics, but I also had to learn to apply it to Accounting, and Finance, WHY!? All of which made for many a tear-filled day at the professors’ office. Every now and again, I did feel lonely and left out in my cohort, but my resilience and adaptability would kick in and I would win the little battles.

IMG_0800Economics was good as long as it was Macro Economics and the professor who worked for the FED was a kindly older gentleman with a thick Texan accent and a friendly smile. Still, I spent too many afternoons in his office at the high-security Federal Building downtown San Antonio. Corporate Restructuring was okay at the start until we got deeper into the mathematical aspects and calculations, then it ceased to be fun. Since I love words, Organizational Behavior was great, Ethics was a bit confusing. Marketing, Negotiations, Business Strategy, and International Business Studies were easy for me because I had no numbers to worry about, furthermore, I LOVE reading and discussions. Looking back now, one of my favorite subjects was Leadership. Not only was our professor really cool and soft-spoken, but the cases were also interesting, intriguing and thought-provoking. I enjoyed learning about exemplary leaders. I learned about myself and my own flavor of leadership. I thoroughly enjoyed the final TEDx talk we each had to give at the end of the class. Oh, my talk was on the power of the word, NO.

One of my favorite experiences during my business school was Executive Coaching. As a matter of fact, I owe my executive coach, my entire career journey today.  She is one cool Chica. She used to work for NASA, so she is equal part brains, beauty, class, and control. I absolutely admire her poise and her presence. She exuded knowledge and she helped me figure out who I am/was, and what I wanted to do with my life after school. Truth be told, I only signed up for the MBA partially because the VA was footing the bill, and partially because I used to counsel my subordinates in the Air Force to take advantage of the GI Bill and Post 911 educational grants and go back to school and further their education. I never even thought I could do it, but I had to heed my own advice.

Singapore 4.jpgI must say the highlight of our entire MBA experience was the 12day international trip to South East Asia! A trip that cost me the attendance of my youngest brother’s wedding in Nigeria, which just happened to have been scheduled for the exact same day. We left San Antonio bright and early that January morning and went through LAX. The 17hour flight both ways was no match for the excitement I felt in finally seeing the world famous Singapore and Vietnam! I grew up in the 70s and 80s and remember listening to the song “Vietnam” by Jimmy Cliff, so, this was a sort of homecoming for me. Singapore, a country born with a golden spoon, is eating its cake and having it too. It is an example of how hard work pays off no matter what. Vietnam, a country that is well on its way back from the ashes of multiple wars, betrayals and “destruction of men in their prime, whose average age was 19” a la Paul Hardcastle in his Jazz Masters hit (one of my faves).  After everything she has been through, her people still wake up every morning, practice Tai Chi, get on their motorcycles and ride!

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I cannot put in words the excitement of Singapore! Its clean streets, ultramodern Singapore 2.jpgarchitecture, eclectic suburbs, fine dining, high-end shopping, educated minds, and multiracial indigenes all living harmoniously in spite of differences in religion, language, customs, cultures, etc. A hard lesson for all African countries to learn (sadly). Singapore welcomed me with open arms. I even got a chance to sing old Karaoke tunes with a local band at a local pub! Vietnam was different. More real, dirtier, noisier, almost “happier” than Singapore. Our class got to visit the Crocs factory, eat with the locals in a traditional Vietnamese home, and take a canoe ride on the river to the coconut village, where my sense of smell was completely mesmerized by the indescribable smells of coconut. Since my wife is part Island girl, and I am the quintessential Tropical Chic, this, was HOME! I was immediately taken back to my childhood, my grandmother’s hut…her smell, her heart, the essence of her being my Nne Akuobu.  As unbelievable as the trip was, I topped it up, by finishing the final edits of my first of many Amazon bestsellers on the plane ride home! BTW, get your copy on Amazon or on my website, it is the best parenting book ever! 😉Singapore 3.jpg

I shall miss school. I have always been studious. I have always had a quest for knowledge. Though old age is setting in and my memory is not quite as good as it used to be. I am proud to say that I completed the MBA and can now print out my new business card with all five letters in their proper order MD/MBA 🙂 I earned it. Considering I got the degree after I have already been in private practice for nearly 30yrs, and considering I have no idea what I am going to do with it…yet, I am still thankful for all the potential doors it will open for me. I admit I had NO WHY, I simply did it because I could, because the funds were available through the VA, and because I might have needed to prove to myself that I still gat it after all these years, or simply because…

In ending, I would like to say; just like that, my 27month program is done. Was it hard? Yeah! Is it doable? Hell yeah! Can you do it? All day! So follow your heart, try something new, push yourself. No one ever died wishing they spent one more day playing a round of golf. This is my legacy, what is yours? What is holding you back from following and fulfilling your dreams? Work? Kids? Family? What are your priorities? Are they in proper order? Remember, life is what happens while you are busy planning…so get off your phone, get off your couch and just do it! If I could do it, with my schedule, you can do it too! Peace still.

My name is Uchenna Umeh, MD/MBA, and I approve this message.

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UU

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#neverforget #alwaysremember

 

Dear Blog, as Black History Month comes to an end…

I want to say this to you, to my people, the Black Butterflies, and Black Bees, and Black Hornets out there…

You know who you are, you know yourselves,

stand tall, stand proud, take a knee, take a bow, be strong, but whatever you do…

 

 

#neverforget

#alwaysremember

 

They came from the African coasts

from the Motherland…

from the belly of the seas, the depths of the ocean

My people,

My ancestors,

Aunts and uncles, yours and mine.

 

Look closely,

See the furrowed brows?

Hear their anguished voices?

Listen to the wailing from the depths of their hearts;

the unborn, the children, the youth, the grown, the aged.

 

Their pain, oh, the pain!

I feel it, fresh as it were today.

Our wounds, still hurting from yesteryears,

…and fresh ones today cut deep

Our scars, never healing

Different, yet same.

 

The anguish in her furrowed brows

The cramps in his tired limbs

The cries from babes at the breast

The wailing from youth in pain

The torment that knows no end

Suffering and wondering, where is God?

 

Praying, asking, is this life?

Lives still in limbo

Thoughts still displaced

Hearts still bleeding

Minds still unknowing…questioning,

…wondering and wandering

 

Ashamed, confused, scared, angry, sad, dejected, unhappy but believing…

 

Today like always, we remember, we never forget.

 

Happy BHM

Black history museum pics

BB

 

 

[BOOK ALERT] My New Amazon #1 Bestseller! (PDF Now Available!)

“How to Raise Well-Rounded Children”

This is the first of my “How To” series for parenting E-Books I am writing. I am truly honored to share some of the knowledge I have acquired over the years with all of you. I had a lot of fun writing it, and I hope you feel the vibes as you immerse yourselves in my words.

In these series, I try to help parents navigate the sometimes-daunting-but-mostly-fun-and-ultimately-rewarding task of raising children, particularly teens.

Book one covers 16 guiding principles that have worked for me for over 20 years of motherhood. I focus on how to raise well-rounded, productive and resilient children in today’s world of instant coffee, instant messaging and quite frankly, Instagram.

Resilience and Kindness are the top principles I believe will make a difference in our children when it comes to the topic of bullying. As a National Keynote Speaker on Bullying, Teen Depression and Teen Suicide, these books are my way of sharing a lot about what I have learned that could help curb the alarming rates of Bullying, Depression, and Suicide in our young ones.

The book also provides easily implementable practical tips for parent engagement with their children. The main theme, however, is leading and teaching by example.

I hope you enjoy reading it and come back in the next few weeks for book two and the rest of the series over the next few months… Cheers and Happy reading!

Buy your copy

[EVENT ALERT] Dr. Lulu’s Parenting Your Teen Workshop (March 30th)

Dr. Lulu’s Parenting Your Teen Workshop is geared toward parents who want to understand AND improve relationships with their teens. Join us!

About this Event

Are you a parent? Do you ever wonder if you are “parenting” right? Do you have a teenager? Do you have difficulties communicating with your teen? Do you worry about them? What they are doing, who they are with and what they are up to on their phones? Ever wonder how they are going to turn out as adults? Would you like to spend a day bonding with your teen and getting to know each other better? Would you like to meet other parents of teens and learn their parenting strategies and share their experiences of raising children in today’s world?

Then come join us at the first ever Dr. Lulu’s Parenting Your Teen Workshop (PYT) happening right here in San Antonio!

Dr. Uchenna L. Umeh, AKA Dr. Lulu, The Momatrician, is a Pediatrician and 30 year veteran in clinical practice. She will be teaching principles from her brand new E-Book; How to Raise Well Rounded Children, available now on Amazon Kindle here

There will be lots to do; From Motivational Speeches to Group Zumba, Team Building activities and Great food and drinks (by our host Bar-B-Cuties Smokehouse on I-10 between Papadeaux and The Porsche dealership) and LOTS MORE!

Come spend your Saturday with other parents and bring your friends and family. We promise you won’t regret it…hey, you might even get to understand your teen better and what parent wouldn’t want that?

Get your tickets now while early bird tickets still last!

See you there!

 

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BEING US

Being…

 

I, me, myself

You, she, her, yourself

We, us…being

Being us

 

It’s the being here

The staying there

The saying

The needing

The sharing

 

Seeing, knowing, smiling

Understanding

Talking, telling, speaking

 

The silence

 

Feeling your presence

Even in your absence

Your being here and there

 

You, me, us, we

Touching, sensing, wanting

Crying, laughing, doing, musing

 

Being

Simply being

Human beings, us

Love – Us

 

Happy Valentine’s Day Baby !

 

BB

Is Your Child THE BULLY? 5 things every parent must do NOW!

Dear Blog,

Happy New Year…I only wish my heart was happy as I write these words this morning. The title of this blog literally pulled me up from bed, begging to be written, so here goes.

We see them on the news every day, we see them on social media every time we look at our handheld devices. Headlines: “X-year-old boy hangs himself, X year old girl found hanging in her closet” “X-year-old teen dies from self-inflicted injuries”. The headlines are not the problem though, read a few lines down and you will see them, the unmistakable words “after years or months or even weeks of being bullied” BEING BULLIED? by whom you ask yourself, then it never fails, the words, by his or her peers follows every time, and I am sick of it!

I am sick of the fact that small children are now more pre-occupied with bullying each other than playing in the sandbox or with their X-Box. Even when they do play in said sandbox or on the X-Box, they are bullying each other. They are teasing each other, they are making fun of each other, and not in a nice way, in the worst possible ways, saying the worst possible things to themselves. I often speak of how another 12-year-old child once told my then 12-year-old son “when God made you, He left you too long in the oven and you got burned” referring to his skin color. How does a 12-year-old come up with those words? Sadly, the vocabulary is now even worse, they have now progressed to calling names like “bitch” and “slut” and phrases like “go kill yourself”, and “die now” as in the case of McKenzie Adams, a 9-year-old child from Alabama who hung herself in her closet last December after months of bullying by other 9-year-olds. 9-year-olds? What do they know? How did they come up with so much meanness and hatred in their hearts and mouths and fingers? Where will a 9-year-old child find such racist statements as those that were repeatedly uttered to this poor little girl? Where are their parents when all of this is happening? Who are these people?

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As if that were not bad enough, just yesterday, the news broke about little Seven Bridges, a 10-year-old boy who not only had a medical condition that required him to wear a colostomy bag (and need multiple surgeries to live) about which he was repeatedly teased, he was allegedly called the N-word and “choked” on the bus by his “bus-buddy” for simply being himself. Where do I start? Who are these 10-year-olds and who are their parents and family members? What examples are we setting for them? How are we handling our home environments? Where are they learning this hatred from? What exactly is going on in our homes, in their heads, in their hearts?

It is easy to blame the teachers and counselors and the school system for not “checking the bullying at school”, but what about at home? What is happening there? Are we as parents now simply having children and leaving them to be raised by others? As a part of the village it takes to raise children, I must say, it is not my primary responsibility to raise yours for you, just as it is not yours to raise mine. We MUST as parents, stop and retrace our steps. We MUST accept our own responsibilities and accept the roles we are playing or not playing when it comes to raising our kids right. We MUST accept our own fair share of blame and then, maybe, we can seek to rectify. We MUST as a matter of urgency resist the urge to play the blame game. Enough already.

Earlier this week, the news broke about the suicide streak in Australian teen girls, a total of 5 girls aged 12-15 years have taken their lives since the beginning of this year, 2019. Blaming everything from child abuse and neglect, to sexual abuse, to poverty and even poor governance, nowhere does this article mention bullying, however, Rochelle Pryor’s last Facebook post clearly stated: “once I’m gone, the bullying and racism will stop”. This shows that even when reported, the news can sometimes be skewed, further compounding the problem and delaying any solutions.

As a pediatrician, child advocate and teen expert, the least I can do is join my voice with others trying to make a difference, to put an end to bullying by our children, at school, at home, at work, and wherever else it might be. Here are five (5) things every parent must do, today, now, in order to help in the fight to end suicide from bullying.

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TALK to yourself. Start at home. Check your life. It is the mirror through which your children look at life. How are you living it? What kind of language are you using when you refer to people of other races, or other convictions different from yours? Is there some domestic violence or abuse going on in the home? Is there name calling? Are you putting yourselves down in front of your children? Do you argue a lot? Should you be in counseling? Do you speak to your children about what they should not be doing or saying in school? Do you even know your children and who they hang out with at school or at play? We must realize that if our kids are the bullies, it might not all be their faults. They might be needing some love, we might be needing to change the way we are doing things at home. They might need counseling or therapy. I recommend we watch this 2006 movie about 5th graders called “how to eat fried worms“, it touches on bullying at home and some of its consequences.

TALK to your children. We are going to have to tackle these questions head-on. Ask them the question directly, “are you a bully at school, on the bus, at the playground, on the internet, in your group chat?” Explain in the simplest terms what you mean by those words. My youngest son was a member of a group chat where some name-calling was going on one time, I saw it when I looked through his phone. I addressed it, made him report it to the school authorities, and he lost his phone privileges. He had not participated in the name-calling, but he had said nothing in the child’s defense either. 70% of children are bystanders when bullying is going on. The child being picked on in the group chat has Tourette’s syndrome, a disability he cannot help. And my child’s behavior was not good enough for me. Ask your child if he or she is bullied, or if they are bystanders when bullying is going on. Ask them what they do if or when they observe bullying going on. Now, if your child is neither the victim nor the bystander, maybe he or she is the bully. Go through your child’s room and their things, see if they happen to have stuff that does not belong to them. This might be a sign.

TALK to their friends. This means we have to know their friends, and better yet, their friends’ parents. When my youngest son David, 14, had some issues with bullying at school, (he was having a hard time transitioning after his two brothers went off to college) one of his friends’ had told his mom, who in turn told me. He had taken someone else’s lunch and eaten it, and lied about it, among other things. Ask their friends directly if they are bullies, or if they know any bullies in the neighborhood, or if they themselves are bullies. We must be seen as part of the community when it comes to raising our children. I had to have a chit-chat with David’s friends a few weeks ago after I overheard him say to David, “if you don’t come out and play ball with me, then you are gay”. I was like, “what?” Apparently, the kid had wanted to play ball with him but David had made an excuse about having to finish up his homework and needed a rain check. After a little tet-a-tet with the young lad, we fist-bumped and I went along my way, content that at least for that moment, I had stopped that line of thinking.

TALK to the school. Yes, of course, the school is the extension of the home. After taking care of the home front, we must engage the school. Most of the parents of these children we read about had frequent engagements with their kids’ schools. We have to ensure that the school sees us as a present parent. You must be all about your child’s business. Get to know your child’s teachers, get to know the counselors. Get to know their coaches, their dance instructors, their tutors. Anyone who imparts any kind of knowledge on your child you should get to know. Believe me, that will make a huge difference in the end. Imagine your child was about to bully someone, the fact that they know – you know their teachers so well will put a bit of a hindrance on that tendency. Furthermore, the teachers will be your second set of eyes and ears when it comes to guidance and assistance with your child. Having an alliance with your child’s teacher can only be a good thing. Unfortunately, we hear lots of stories of how the schools in some cases claim they had no idea any bullying was going on. Like the case of 8-year-old Gabriel who was knocked out in the school bathroom by bullies a few days before he hung himself.

TALK to a healthcare provider. If you do find out that your child is the bully (and believe me, this happened to me) Talk to someone. Talk to someone right away. Get them counseling. That made a huge difference in my child. It helped us realize and understand the reasons behind his actions. There are licensed therapists, psychologists, psychiatrists and pediatricians like me waiting to help you and your child. I understand that we never want to believe our children are capable of such horrific acts we read about in the news, but, they are. We have to change our mindset about that. We must do the needful and help them because the bully often resorts to that behavior as a result of their own inside pain and stress and trauma and insecurities. They too sometimes may have been a victim and as such, need some love and understanding and care. Let us remember that babies are born, innocent, then life happens. We do not of all things want to be the parent of the child who was in any way responsible for the death of another. So, pick up the phone, make that appointment and speak to a healthcare provider about your child, the bully, you’d be glad you did.

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An edited and truncated version of this blog was accepted as a guest blog post on Successful Black Parenting Magazine, check it out here.

BB

  Doctors, make sure that patient REALLY needs those antibiotics…

 

In this cough, runny nose and colds season, I cannot find any more befitting time to publish this article, that I first wrote for kevinmd.com last month in honor of the National Antibiotic Awareness week here in the US (November 12-18) It has become such a huge problem, that I am planning a TEDx talk on this topic in 2019 (stay tuned). I feel helpless sometimes, worse still, I feel hopeless most times when I think about the future of our world, our universe with antibacterial resistant germs aka superbugs. As a pediatrician, I have continued to experience a huge pushback from parents, and it is mostly NOT their faults. WE, care providers (Doctors, Midlevels, Pharmacists, Nurses, Medical Students, Residents) have all played major roles in what I call “excessive antibiotic prescription syndrome, or excessiveantibioticprescriptionitis“, #ANOTHEROPIOID-LIKEEPIDEMICANYONE?

These days, no one waits for the body’s immune system to work anymore, no one waits to see if the child or adult for that matter, can fight the infection anymore, no wonder our generation is getting less and less able to fight even the most mundane of infections. We are ALL in a rush to get better, real fast, so we continue to perpetuate the behavior.

For those of you who have been following my story since this summer of 2018, you will remember that I quit my nine-to-five job to pursue a carrier in public speaking on a more semi-permanent basis. I started working part-time with a National Telemedicine company. I am extremely excited about the opportunity and I am very satisfied with the options it has given me to stay home, as I complete my Executive MBA, as well as spend time with the family, a rare opportunity that I have never had in my entire adult working life of almost 30 years. I have realized that there is more to life than working for the man. I have gotten to know my children again. For instance, my eldest son who is a junior at Stanford University came home for 2 weeks this summer and I was able to spend time with him one-on-one. I got to meet the man that he has become and got to know him on a totally different level. In essence, he left my home almost three years ago as a boy and came home this summer as a man. And I am eternally grateful for the opportunity, but I digress.

Unfortunately, this blog is not about me and my children, it is about the fact that in the last 16 weeks, with this new and fun experience of independence and a new way of practicing medicine (for me), has come a new revelation that is rather disturbing. The following, are 11 quotes from my telemedicine patient/parent encounters that have recurred pretty much since my days in private practice but more so in the past few weeks.

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Photo by Pixabay on Pexels.com

“Hello, doctor, my son has had a fever for 4 days now, is there a way we can get an antibiotic for that, please? Thank you.

“Ma’am, I know my body very well, and I know that when I get like this, the only thing that fixes it is an antibiotic”

“Her cough is really deep, and she has greenish-yellow mucus, I think she needs an antibiotic”.

“My children have been running fevers off and on for about 3 days now, the last time they were like this the other doctor gave us an antibiotic and it worked, can we have it again this time?”

“All the other doctors we have spoken to have given us antibiotics I don’t understand why you won’t”.

“Are you saying you’re not going to treat my child?”

“…and what if his stomach doesn’t get better in two days, does he now get an antibiotic at that time?”

“So, how long does he continue to cough before he gets an antibiotic?”

“Can my little girl get an antibiotic for a pink eye? I know it’s a virus but I feel like an antibiotic will help, it did the last time”

“Sir, simply look back at our records, you will see that she gets antibiotics every time she has a ‘sinus infection’, that is the only thing that works for her when she gets like this”

As doctors, we all know that antibiotics are good, but they can also cause life-threatening problems when used recklessly, or when used excessively. However, in my opinion, I do not believe that we have done our due diligence in educating our patients and their parents appropriately to this point, hence their constant reliance on antibiotics for improvement of symptoms regardless of etiology. Even if we have done a fair enough job so far, I believe there’s a need for persistence and insistence on daily teaching of ourselves, our mid levels, our patients, trainee residents, and the entire medical team about the dangers of antibiotics, and especially, the dangers of their over-prescription. At this point I feel like we have to proceed with reminding ourselves; one doctor at a time; one trainee at a time; one pharmacist at a time, and one midlevel provider at a time, about the need for hypervigilance in this matter. I dare add a quick reminder that Sir Alexander Flemming himself said “ The greatest possibility of evil in self-medication with penicillin is the use of too-small doses, so that instead of clearing up the infection, the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out which can be passed onto others until they reach someone who gets a septicemia or pneumonia which penicillin cannot save. In such a case the thoughtless person playing with Penicillin treatment is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted”.

I find this quote extremely inspiring, however, even though his original fear was for under-dosage of penicillin, our problem today entails both underdosing and overusing. As much as I worry about my patients who have confided that they “shared the Amoxicillin meant for one child among the three children” or they “used the left-over Omnicef from last time, this time, because little “Misty” had the exact same symptoms as little “Joe” did the when he was sick”, hence perpetuating underdosing behavior, this write-up is mainly about overuse of antibiotics, and not only in humans, but also in livestock (something I rarely think about) In a 2015 paper, Business Insider wrote that in her TED talk, Maryn McKenna, a journalist, had cried out about the excessive use of antibiotics to fatten farm animals and prevent them from getting sick, thus causing widespread presence of antibiotics in circulation, leading to bacterial exposure to inappropriate doses, and therefore, resistance.

In a recent article published by the Journal of Antimicrobial Chemotherapy titled “antibiotic treatments and use in hospitals and long-term care facilities” it was observed that 30% to 50% of antibiotics prescribed in hospitals are unnecessary or inappropriate”, thus underscoring our own contribution to the situation. In that article, they refer to the term “antibiotic stewardship” as a process of evaluation and optimization of antibiotic use. It is being increasingly promoted as a means to reduce antibiotic resistance, adverse events, treatment complications and costs within institutions. Unfortunately for us practicing physicians, the recent WIRED article from March 2018 titled; The Yelping of the American Doctor by Maryn Mckenna, indicates that 2 million Americans are sick yearly from antibiotic related issues, and calls out us doctors as being part of the problem, when we write antibiotics for viral infections and or we give low-doses, the wrong dose, the wrong directions for use, or the wrong antibiotics for the ailments. It further points out that all of these factors contribute to the patient being sick, and developing antibiotic resistance and that antibiotic resistance costs the US  2.2 billion dollars in medical expenses yearly. Pressure and fear of bad online patient satisfaction scores are the main reason given by doctors that were surveyed for writing unnecessary antibiotics, as evidenced by the just-released NPR article titled Patients Give Doctors High Marks for Prescribing Antibiotics for Common Sniffles which notes that patients felt more satisfied with their doctors’ visits when they received antibiotics for upper respiratory tract infections, whether they needed it or not. As a result, doctors are now writing prescriptions for the patients who for the most part do not know what they’re asking for or why. Some of the other reasons cited include physician fatigue at the end of the workday and “just-in-case” situations like those that arise at the urgent care settings or with a new patient in the office.

The struggle is real for us doctors. One time I found myself arguing with a patient’s mother on the phone, who according to her, knew her child’s body and knew that “only an antibiotic would fix the problem”. She got really upset because I essentially refused to give her 17-year-old daughter an antibiotic prescription for a maternally diagnosed “sinus infection” after 4 days of symptoms of nasal congestion and cough. She challenged me and actually threatened to lodge a complaint against me, to which I gingerly informed her that I would be glad to do the same, and I did. I stood my ground and refused to give her what she wanted, strictly because her child did not need it, prompting her to declare that she would simply call back and get another doctor and would get her way!

addiction antibiotic capsules cure
Photo by Pietro Jeng on Pexels.com

Luckily for me, these experiences have not deterred me, over time, I have persisted and continued on my mission to educate my patients, and more and more of them are now doing better with listening to me and trying to understand my reasoning. Many of them actually thank me, happy that someone took some time to explain the proper reasoning to them. On my part, I always end the talk by empowering them to take a moment next time their provider prescribes antibiotics for themselves or their children, to respectfully ask that burning question: “doctor, does my child really need those antibiotics?”

As a Nigerian-born physician, the plight of my people in the third world countries has not escaped my mind. In Nigeria, like in most developing countries, people still generally walk up to the chemist or pharmacy and purchase medications over-the-counter, antibiotics included. That behavior, in addition to the lack of effective government regulations amongst other issues with healthcare delivery, puts us all in even greater danger of antibiotic resistance and further underscores the fact that in September of 2017, the World Health Organization described antimicrobial resistance as “a global health emergency”.

Finally, I am writing this piece as a gentle reminder to each one of us to remember our Hippocratic oath “to first do no harm”, to educate the patients repeatedly until it sticks… and never tire in doing so. This, I say is one time we MUST all stick together and speak with one voice. Otherwise, it puts some of us who still do so, in a weird light. Sometimes it might be necessary to be firm and insist on doing what is right in order to practice good medicine. And in case you are thinking otherwise, always remember that never has it been known that a defendant told his defense attorney exactly how to defend him in court. Our patients should neither be telling us how to treat them, nor threatening us, nor grading us better, based primarily on antibiotic prescriptions.

 

“Widespread use of antibiotics promotes the spread of antibiotic resistance. Smart use of antibiotics is the key to controlling its spread”   A. P. J. Abdul Kalam

“When antibiotics first came out, nobody could have imagined we’d have the resistance problem we face today. We didn’t give bacteria credit for being able to change and adapt so fast”.   Bonnie Bassler

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