Monthly Archives: November 2011

“So, you’re having sex, right?”


“So, you’re having sex, right?”  “Well, why not??”

This is how our adolescent medicine doctor/professor opens that conversation with the teens that she sees in her office on a regular basis.  Ballsy, right?  A little uncomfortable?  As in, what on earth is she getting at?!  Why would you assume that they are having sex, and then ask why not if they say “no?”  Before you freak out, I have to say, it’s pretty brilliant.  See, most of us in our PA class are thinking to ourselves “how on earth am I going to talk to teenagers about drugs, sex and rock’n roll in a way that isn’t school-marmy, authoritative, wrist-slappy, awkward,. nausea or cricket noise inducing….” and I feel like after listening to this particular professor share how she communicates with them, I actually may not need to take a benzo before walking into the room.  The fact is, she says she rarely has kids lie to her (concern #14 on my list,) and asking this way is disarming because it shows that you have a realistic grasp on current adolescent behavior, and are not going to judge them.

So read below, the statistics are also unsettling.  I was a teen not too long ago, and I’m not sure how much has really changed in youth behavior- when your noggin isn’t fully developed until your twenties, you will do stupid thing after stupid thing. The following statistics are from surveys taken in schools.  So that disregards how drop outs, private school attendees and homeschoolers would respond.  I have a hunch that these numbers are actually HIGHER in reality.

  • 17% of female HS students have seriously considered suicide in the prior 12 months before being surveyed
  • 13.2% actually made a plan
  • 10.5% male students considered it
  • 9.6% actually made a plan
  • 11.4% 12-17 year olds reported using cigarettes in the prior month, that would be 6.5% 8th graders and 20.1% 12th graders
  • 14.6% 12-17 year olds consumed at least one alcoholic drink in the prior month, 8.8% had binged
  • 10.9% 8th graders, 23.9% 10th graders, 32.4% of 12th graders had abused marijuana at least once in the year prior
  • 1.9% 8th graders, 6.7% 10th graders, 9.7% 12th graders had abused vicodin in the prior year
  • 20% of high school students who drank or did drugs before sex (same stats since 1991!)
  • 46% of high schoolers who admitted to having ever had sex
  • 40% are not using condoms, 80% are not using birth control pills
  • 34% (the largest proportion) of NEW HIV INFECTIONS annually are aged 13-29

So, if your kid’s senior high school class has 200 kids in it, 34 girls and 20 boys are considering suicide, over 40 are using tobacco, thirty or so are drinking every month (probably way more than that), sixty are smoking pot (that’s right- SIXTY), twenty are abusing prescription pills, FORTY are using drugs and/or drinking before sex, half the whole class is or has been sexually active, most of them are not using protection from STDs or pregnancy, and many of them will obtain HIV transmission because of their sexual behavior.  WHAT?!!!!

Would you want your kid to go to that school?  Unfortunately, this is reality.  So, is it really that inappropriate to ask,

“So you’re having sex, right?”

But there’s follow up there, if they say “no,” and I ask “why not?”  I can get a sense of that young person’s courage, moral decisions, family involvement, concerns, education, and I can ENCOURAGE them in their choices.  If they say “Yes,” well then it doesn’t take much time looking at the above risks to see where our conversation will go next, as in, “let’s talk about how to protect yourself from STDs and pregnancy!”  There’s still a LOT of work to be done out there, obviously.  Sure we wish that everyone would make safe sexual choices, but when half the kids are having sex, a bunch are using drugs or alcohol at the same time (you’re not using condoms if you’re drunk or high,) and a huge percentage are using no protection at all, we need to wake up and smell the coffee, People.  Folgers hasn’t changed, and neither has kids’ behavior.  Not to mention all the risks of abusing drugs, alcohol, prescription meds, etc.

I think my major take-home message is I MUST ASK ABOUT EVERYTHING.  If perfect-looking soccer moms are abusing crystal meth and benzos, then you can be damn sure that high honors star lacrosse player Suzy is sleeping with her boyfriends and smoking pot, and maybe has contemplated ending her life.  ASK, ASK, ASK.  Because if I make an assumption about someone’s behavior based on my impression of them, I may miss one of the most important conversations I need to have with them.  Like how much they’re at risk for HIV or other STDs, and how we can prevent it.  Or how to avoid a scholarship-ruining pregnancy.  The stats show that they’re doing these things, so I better be prepared to ask about it in a way that is less “you’re not doing drugs, are you???” and more “So tell me about your drug use.”  Here’s hoping that our whole society will be more open and frank with our adolescent population, so that I’m not the only person they are talking about it with.


Medical Fear-Factor: Cross Cultural Patient Care-Muslims


Well if you know me, then you know my history-raised in the mysterious, chaotic, lively and noisy land of Egypt, far away,… where I was immersed in Egyptian culture, comprised predominantly (but not completely) of Muslims.  I went to school with them, played sports with them, argued politics with them, bought vegetables from them, rode in their taxis, rode on their camels, ran the mile in PE with them, was a third grade teacher for a few dozen of them, shared many treasured memories of life with them.  Although Muslims make up a large portion of the population in major cities across the United States, there exists a significant void in understanding and communication between…. what shall I call it,… traditional America? and Muslims; peoples from other cultures that share a common religion, seen as a foreign and suspect.  Now that I’m in PA school, I feel that this “void of understanding” is unacceptable, if we are to provide excellent patient care to whomever walks through the door.  So, I decided to do something about it.

As you may know, Global Health is my passion, and I hope that I will be heavily involved in the alleviation of Global Health maladies as a career and life-pursuit.  Thus, I joined the University of Utah Student Global Health Initiative, a group of students from various health colleges that share similar interests with me.  I had been sort of bouncing around ideas with one of my PA classmates, an amazing woman by the name of Wagma, born in Germany to Afghani parents, raised in the United States, and one of the most intelligent, motivated, organized and impassioned Muslim women I’ve ever met, which evolved into holding a panel discussion event, hosted by the SGHI, that would feature members of our local Muslim community, people who are working in healthcare or Public Health who could share about their faith, dispel rumors and stereotypes, and provide pertinent information to the attendees about how to take care of Muslim patients.  It was occurring to me that most people, even in my class, had very little experience or knowledge about Islam or people from cultures that practice Islam.  And yet, they would be taking care of patients from these cultures, wading into the bogs of cultural ignorance, terrified to offend someone or aloof due to their own misconceptions.  With two Muslim women in our own program, one would think that surely people would feel comfortable just asking them their questions, but, this doesn’t happen very much.  The Panel discussion, however, was the perfect medium for people to come and learn, ask those questions and gain a sense of confidence in how to approach, say, a woman who wears Hijab, or a patient who’s fasting for Ramadan, or can we/should we/is it allowed to perform a pelvic exam on an unmarried woman?  This is heavy stuff.

Suffice it to say, we held the event, and about 50 people came.  I thought the panelists were wonderful, and addressed so many issues I can’t even remember them all.  We plan to hold a series of these talks, each time featuring a new cultural group or religious group.  SO, if you are interested, here is the video of the event, I am so proud and pleased at how successful it was.  There’s no way that in one hour, you can achieve complete vulnerability, transparency, and understanding.  But you can at least START the conversation.




A year Ago This Weekend,..


A year ago, this weekend or so, I was beyond nervous as an interviewee here at the University of Utah, two days after interviewing at OHSU and a week after interviewing at Pacific.  It’s hard to describe that sense of anguish, desire, hope, uncertainty, and wonder about the future possibilities.  I definitely re-experienced it last night as I stood in front of this year’s crop of interviewees on the Q&A panel, answering questions that I remember asking a year ago.  I reassured a bevy of polished, intelligent, accomplished and terrified women who were just as worried about their interview performance yesterday as I was a year ago.  I tried with all my might to persuade them that they ARE indeed capable, otherwise they wouldn’t be here, and that there won’t be a really good reason why if they’re not admitted this year, because they weed out hundreds to interview eighty-eight, of whom they will choose forty-four,. and yet all eighty-eight are qualified.  I can’t express how happy I am to have made it.  I can’t believe it’s been six and a half months of intense learning, and I’ve made it so far.  I can’t believe the incredible ways that God has paved the way for us here in Salt Lake, the friends he’s brought into our lives, the spiritual lessons he’s teaching us, the unbelievable learning experience I’m having.  I really am one of those people who over-reflect on everything,… so it really is intriguing for me to stop and consider all that has taken place in the past year that has so dramatically changed our lives.  If you had told me, even as a senior at Westmont where I’d be today, I’d be freaking excited, and dumbfounded!  Really?!!  I get to be a teacher AND have an amazing medical career???  Even though I’m freezing my butt off right now, because I moved from a winter climate to a winter climate, there’s a blanket wrapped around me, two mugs empty of hot chocolate on my desk, a cat in my lap, and my little space heater on overdrive under my feet, watching the snow fall outside,… I am jazzed beyond belief.  Just as jazzed to be here as I was listening to an amazing lecture on Chronic Fatigue Syndrome and Fibromyalgia yesterday, but one of our nation’s experts.  This is just beyond cool.  So, here’s to a year from now, where I’ll be in the middle of my clinicals, putting all of this information together, staring down the end of my schooling towards the horizon of possibilities.  Giddy is how I would describe my feelings towards all of this.  Giddy, and overwhelmed by the love of a God who blows my mind everyday.  Peace.