Monday, September 14, 2015

When & how to tell your child that he/ she has been adopted?

When Katy Mobley was 3 days old, her parents sent out adoption announcements to their family and friends. Early on, they also made a point of regularly telling their daughter how wonderful it was to have adopted her. "From the moment we brought Katy home, we wanted her to feel that her adoption was a positive event," says her mother, Marilynn, of Marietta, GA.
Katy, now 14, feels comfortable asking her mom and dad questions about her biological parents. The Mobleys are convinced that they can communicate so freely because they were open about their daughter's adoption from the get-go.
Most experts agree with the Mobleys' approach and suggest that parents talk openly about their child's adoption, even during infancy, to set a good tone for later on, when children will want to explore their feelings on the issue. Ultimately, an open atmosphere helps them to grow into self-assured adults, says Lois Ruskai Melina, author of Raising Adopted Children.
Of course, a child's understanding of adoption changes as she matures. Most kids don't start to grasp the concept until age 5 or 6, but if they've been prepared, they won't be shocked when the story does click.

Here are five ways to keep the lines of communication open:

-Use the word "adoption" regularly. The word shouldn't become your primary focus, but say it when it feels natural. This way "adoption" never becomes taboo.
-Share stories. Read books about adoption, such as The Day We Met You, by Phoebe Koehler, and Let's Talk About It: Adoption, by Fred Rogers. Or weave your own tale: Richard Gellerman, of Tucson, AZ, told his 1-year-old daughter, Kayla, about a little squirrel whose parents didn't have enough nuts to give her, but were able to find another mother and father who did. "Kayla didn't yet grasp the fact that she was adopted," Gellerman says, "but the story helped to introduce her to the concept."
-Create a memory book. Little kids love seeing what they looked like as babies and learning about their own history, even if they don't understand every aspect. When Katy Mobley was 1, her mother showed her photos of the day they brought her home. There was even a snapshot of the adoption agency.
-Take cues from your child. If she asks, "Did I grow in your tummy?" explain pregnancy and birth in the context of her own experience. Say, "You grew inside your birth mother, another woman, and then you came to live with us." If your child doesn't express much interest in her adoption, don't dwell on it. You can be sure at some point she'll need to learn more. Once a 5-year-old becomes fascinated with the human life cycle, she'll want to know everything—from where she came from to how she relates to her immediate and extended family.
-Be patient. While your child might acknowledge that she's adopted, she won't really know what that means until she understands conception and pregnancy, says Sharon Kaplan Roszia, an adoptive mother, and a program manager for the Kinship Center adoption agency, in Santa Ana, CA. So don't become frustrated if your child doesn't seem to "get it," Roszia notes. It's perfectly natural for her to ask questions—sometimes even the same ones over and over again.

Who Else Should Know?

Doctors: Supply your pediatrician with the birth parents' medical records, if you have them. Also let him know about the quality of prenatal care received by the birth mother. Both could have an influence on your child's health.
Teachers: Tell them on a need-to-know basis. For instance, if your child has a genetic tendency toward learning difficulties, informing teachers might help to make sure his educational needs are met.
Friends and Family: Share the full story with them only after your child knows it.

Saying the Right Thing

When your child asks about his adoption, be honest, but don't think that you have to explain everything at once. It's fine to wait until he's older to tell him more, especially if you think the truth might confuse or hurt him (which could be the case if he was abandoned). Just don't say anything untrue, because you may have to contradict it later.
DO...
Emphasize that there's nothing wrong with him. Explain that he was given up for adoption because his biological parents were unable to care for a baby at that time.
Stress that adoption is permanent, so your child won't worry that you'll give him up someday, too.
Talk about your child's birth mother and father. Otherwise, he might conclude that his adoptive father is his birth father.
Encourage your child to discuss his emotions.
DON'T...
Tell a child that she was given up "out of love." She may worry that if you love her, you'll give her up, too.
Say that you "chose" her. In order to be chosen by you, she might conclude that she was unwanted by someone else.
Denigrate the birth mother or father. They have a real connection with your child.
Expect her to come to terms with her adoption immediately. Many kids surprise parents with emotional reactions at age 7 or 8.

Comment: As a Pediatrician and an Adoptive Father, this is something that is close to my heart, and understandably tough for many parents.
In India, we have an additional problem of taboo surrounding the word "adoption". Thus many parents completely refuse to tell this to their adopted child.
While every case is different, I would agree with most child caring experts in that we should tell about adoption to children, and start this in a natural way, so that there is no sudden shock if they learn about this unexpectedly from someone else..
I would love to hear the opinion of Indian parents about this sensitive topic.

Friday, August 28, 2015

Communicating with the parent/ patient in this computer day & age .... some tips

Here is a an interesting guest blog that I really liked ...
You can read the entire blog here (requires free registration)
"How I communicate with patients. Here are a few things I am trying to do differently, and which I similarly challenge you to implement.
1. As you enter the exam room, don’t head for the keyboard, head for the patient. Introduce yourself, ask who accompanies the patient, shake everyone’s hand and thank them for coming.
2. Square your shoulders — to the patient, not the computer. In today’s world of medicine, navigating the computer is a necessity, but at the beginning and end of every visit, take all focus off the computer and square your shoulders to the patient as you speak, educate, and counsel.
3. Find natural ways to weave friendly conversation into your exam visit while maintaining focus on your history taking, exam, decision making, and treatment. Quite possibly the most difficult skill of all, this requires emotional intelligence, clinical expertise, and professional focus.
What other lessons can we learn about patient care, either as patients or physicians?
What can physicians do to ensure the focus remains on the patient and not the computer?
What are some suggestions for weaving friendly conversation into patient visits without appearing to be distracted by the conversation?
Steve Christiansen is an ophthalmology resident who blogs at EyeSteve.  He can be reached on Twitter @EyeSteve.
"

Monday, August 17, 2015

Want To Be Professionally Free Doctor? First, Introspect ... Guest Article by Dr Taher Kagalwala

A lovely article that reflects my moods & sentiments far better than what I hear from most doctors,.. about practising as a Doctor in present day India. This article was published in docplexus - a forum for doctors - by Dr Taher Kagalwal ... 
"Things have come to such a sorry pass in India not just because of the controls that the government is exercising. The fault lies with us. When you decided to become a doctor, there were stars in your eyes. You were altruistic. You wanted to serve humanity. You wanted to be next to God. You desired the status and the prestige that came with being called a doctor.
What happened once you qualified? You forgot your altruism. You forgot your humanity. Glory and fame became your mantra, and the way to it - not by being a great doctor, but by being a rich person. Acquiring wealth took priority over acquiring a good reputation. You no longer cared if the poor came to you or not. Your aim was only to care for those who have the moolah to fill your tijori. In such circumstances, what right do you have to say "We want", when you cannot even begin to understand what your constituency wants. What your patient wants.
They never sought 100% guarantees from you. What they wanted was 100% honesty, 100% empathy, 100% commitment. Did you provide those? Did you spend time explaining - forget about the nuances of the disease - but even HOW to take the medicines you had prescribed on the A5 paper? Did you bother to study the impact of the patient's illness on him/her, on their family and on the society around them? How did you practice charity? You chose to donate to charitable institutions only because they provided you tax relief. Did you give out of your own earnings or simply provided samples of medicines left behind by MRs? Did you willingly write on referral papers to give the patient discounts and forgo your commission? (The key word is WILLINGLY).
Introspect. How well are you united with each other? Every doctor views another doctor - both in governmental jobs as well as in private practice - as their competitor. Pulling each other down in front of patients is more than enough for them to lose respect for you. Today, you pull down X, tomorrow, they pull you down. What goes around, comes around.
You have to change before you expect the others around you to change. Learn to be more empathetic. Listen to your patients. Spend time on the consultations and restrict the number of patients if you want to really help the patients. Avoid multitasking in the clinic. Freely seek second opinions without bothering if the doctor will take away your case or not share the commission with you. Be attentive to the patient's needs but also the needs of his family, Respect the confidentiality of the patient. Seek his permission before sharing his history, prescriptions, photos and so on on social media, even if your intention was to seek help from your colleagues.
I hope this helps many of you to understand why the people of India have grown so impatient with  doctors. They are not fools. Movies cannot be blamed, because they reflect what is already happening. Yes, they take artistic license with this, but that is their right. There is no smoke without fire. Look for the solutions inside yourselves. Don't look at your practice as a means to recoup the millions you spent during your education. That is not the way. Moeny will come - perhaps a bit late - if you stay on the ethical path.
Above everything, stay united, not just to create a crowd at your nursing home when it is under attack, but also to consistently fight bureaucracy, the muscle tactics of private hospitals, the regressive policies of the government, the care of your patients and the well-being of the society.
Happy Independence and Introspection Day to all of you.