I find that anger eating works wonders in situations like this.

Sheesh, what a stupid use of statistics. What's the average weight gain for people without horrible morning sickness? Preferably the subgroup that was confined to inactivity for however long you were confined to inactivity? That's the number we want. This average of all people on earth is worse than no information at all.

More and more I am convinced that I was not in fact too stupid and unmotivated to become a doctor.

Actually, having written all that out, I feel much more cheerful. Now I'm like, "Boy I sound angry in that post."

Tokharian stoner discovered in China.

Oldest stoner yet discovered. I say let's name him "Cheech".

You know, you're stuck with this OB, but you knew he was a bozo going in. Try and just view him as the technician who's making sure there no protein in your urine, and ignore him otherwise. I'm sure he's perfectly competent if something goes actually wrong, but short of that, he's not worth any attention.

Yeah, the average wight gain seems like a pretty meaningless figure if morning sickness is a strong factor. You just end up with a bimodal distribution based on whether or not you had morning sickness. You position along the right-most peak would at least be vaguely relevant, if not particularly important.

Also, do doctors really hassle patients about their weight proper, rather than underlying problems like high cholesterol or high blood pressure? Because weight itself isn't a medical condition.

5: I like bitching.

Oh, bitch to us, certainly -- it's entertaining and probably makes you feel better. I'm just encouraging you to be dismissive about the OB on the basis of the many things about him that make him sound like a nitwit.

I bet he's a Republican fundamentalist child-abuser too.

many women lose up to twenty pounds in their first trimester, due to morning sickness and nausea

Oh, whatever. No morning sickness with any of my three kids, and lord knows losing 20 pounds during your first trimester is worse for most people than gaining a few extra. You're *supposed* to put on weight during a pregnancy. What's "normal" is completely different for different people.

Even if you did gain 60 pounds (which you almost certainly won't), you deliver 1/4 or more of it on Day 0.

You also started out unusually slim (unusually isn't the right word, but you were lean and athletic, without any real cushion of excess body fat). That's going to affect what a sensible, necessary weight gain is.

For example, I started out the pregnancy with Sally pretty skinny, and put on forty pounds. Didn't take it all off, and two years later got pregnant again, and this time put on twenty pounds, so I gave birth at just about exactly the same weight each time. I don't know what was going on exactly -- I ate whatever I felt like both time -- but I figure my body wants to give birth at my baseline lean bodyweight + X.

2: yeah, many doctors are not that smart. You totally could still. Most people do their M.D. Ph.D simultaneously, but I bet you could do them afterwards. You could still do research, but you'd have a back up if you had trouble getting grants.

A couple with whom I was acquainted were expecting their first child. At one of the routine visits the ob stated how well things were going, and prepared to usher the couple out of the office. "Don't you think my wife has gained a lot of weight?" asks Mr. Tact. "Jump on the scales, please....oh my, that does seem like a lot. You better start watching what you eat, and try to get more exercise" says the doc. Daggers for eyes, the not so little Mrs. silently fumes. The couple has since divorced.

The only solution is to post pictures of your ass every few days so we can let you know if it's getting too big.

No morning sickness with any of my three kids

You know it is pretty normal for the father not to get morning sickness.

Wow. After reading that post, I might have to re-think crashing your wedding.

I didn't realize that there was so much rage in you.

I thought in an earlier post, it was stated that the real phenomenon is the surrounding terrain growing apace with the ass, such that the ass is no longer a discrete entity and therefore becomes unmeasurable.

There is a form of diabetes (gestational or pregnancy diabetes) that does what the name suggests and is relatively easy to get while pregnant (so I'm told). For this reason I think it is worth staying away from the refined sugars (there are also other reasons, but this is a particularly good 'un).

They do a test for gestational diabetes -- if you're not showing any signs of it at the test, there's no reason to worry more about refined sugars during pregnancy than otherwise. (Also, why refined? Honey isn't going to give you diabetes?)

I think by refined what is meant is simple, as in simple versus complex carbohydrates. At least that makes the most sense to me.

Even if you did gain 60 pounds (which you almost certainly won't), you deliver 1/4 or more of it on Day 0.

Fifteen pound babies??

That may be what you meant, but it's not what "refined sugar" conventionally means.

21: Baby + placenta, which can be approximately baby-sized, plus a whole lot of fluid volume. Not just amniotic fluid, but blood volume.

21: I think there's a lot of fluids and juices you lose that day, too. Also your blood volume is up like %150, and that starts going down pretty quickly.

I didn't realize that there was so much rage in you.

RAWR!

22: One assumes that 1) generally honey consumption is quite low 2) most people have little clue about simple vs complex carbohydrates but substantially more about refined versus unrefined sugars and therefore 3) refined sugar is a useful meaningful substitute for simple carbohydrate.

placenta, which can be approximately baby-sized,

This is actually way off -- I just looked it up. It's more like 20% of the size of the baby. I remember them looking pretty darn big, but my memory is apparently flawed.

26: Kind of a silly one, though. "Unrefined sugar" means something -- it's that brownish stuff they also call raw sugar, and it's mostly simple carbohydrates. You don't make table sugar by a process that starts with complex carbohydrates and refines them.

re: 21

Plus water, and placenta?

FWIW, my brother was a tad under 11lbs when he was born.

i think one needs someone who challenges the one
so if the doctor was great, kind and supportive you perhaps won't pay much attention to the weight,
(if i were you for example, i know myself)
but b/c he's insensitive you'll pay more efforts to not gain that extra weight like in spite of him
so he's acting maybe knowing that

Complex carbohydrates - starch, pectin
Simple carbohydrates - glucose, fructose

But starch is quickly broken down to glucose.

but b/c he's insensitive you'll pay more efforts to not gain that extra weight like in spite of him

I totally felt this urge, "OH YEAH? I'll show him!" on the drive to work, afterwards. But that's also an old, vestigial, college-age part of my brain who thinks its a great idea to start restricting calories, and so I'm irritated at myself for giving that voice the time of day.

31: Well, right. It's not as if complex carbohydrates are irrelevant to diabetes management either.

30: The point isn't that he's insensitive, it's that it's not actually a problem for her to have gained weight.

Show him up good, heege. Gain 140 pounds, and then give birth to the healthiest and smartest baby ever. And then solve the climate change and nuclear waste problems.

*I* had gained more than 5 pounds by the 21st week of each of my wife's pregnancies.

Wow, H-G, AB only gained 5 pounds total over both her pregnancies. You must be a real porker.

This is another reason that there should be no such thing as a male OB/GYN*.

* I say this even though a wonderful male OB/GYN saved the day and delivered Kai when the rest of the hospital was hopelessly fucked up.

The issue of pregnancy weight is bizarre, and I think the only way to stay remotely sane about it is to be in regular contact with other moms-to-be. I don't know if you're the type to join a group, heebie, but at the very least some kind of listserv or something. My wife moderates a listserv for mothers of her profession, and it was an invaluable community to have during her first pregnancy. Weight gained varies enormously, and without any strong and evident correlations to factors like pre-pregnancy weight, exercise, diet, etc. In a first pregnancy, one's metabolism reveals just how many wildly different things it can do. My wife was somewhat underweight to begin with and gained almost 70 pounds (w/o gestational diabetes or etc); our daughter was born very healthy at 8 pounds even. My wife lost 50 pounds in the first 6 months and most of the rest withing the next three or four, stabilizing eventually at exactly the weight the pregnancy books said she should have started at, about 5 pounds above where she had been.

I should add, IME, OBGYNs are frequently jackasses. With our first child, we went to the local hospitals nurse-midwife center, and so had little contact with the doctor as such. But when he did turn up, he was brusque, patronizing, and delivered only the facts already available in their two-page bilingual pamphlet. With the current pregnancy, there is no midwifery center, and the only available doctor is equally inane. As LB says in 5, be glad they're around for potential emergencies and otherwise try to ignore them.

No offense to any such professionals in the audience.

Also - and this may have been said already - if you're still being active, then weight gain is really meaningless. The ONLY way I could see it being an issue - aside from preëxisting concerns - would be if it was a sign that you had effectively put yourself on bed rest, which wouldn't bode well for third trimester mobility or ability to control (in some sense) your delivery.

The non-asshole way to handle this is something like, "Are you still active? OK, then. Your weight gain is above average, but as long as you're still moving, that's fine. Maybe cut back on junky foods, but don't worry."

Anyway, I look forward to meeting Heebie's 15 lb. newborn at the wedding.

37 - in all seriousness, I agree. The three OBGYNs we've had have all been men, and all have been equally stereotypes of the half-assed doctor dude. Meanwhile we've had access to midwives, fellow parents, and internet communities with tons of accurate and valuable information delivered with sensitivity and attention to individual particularities. Why do these lame-os want to become OBs anyway, if they can't put an ounce of heart or brain into it? Friends who've had women OBs have had complaints, for sure, but much fewer and less serious complaints, and almost always around the issue of tolerance for alternative medicine etc, so you know, to be expected.

On discussion with wife, it is suggested that even doofus men may choose to become OBs because even if one's not so good at it, the patients usually survive and experience the miracle of life etc, which must be nice for the doctor too.

I don't know if you're the type to join a group, heebie, but at the very least some kind of listserv or something.

I have a couple friends who're also pregnant, but also I love my doula very, very much, and she's holding some birthing and breast-feeding classes in the spring with some of her other clients. So there's something of a network in place.

Also the first time we met, she was extremely vocal against the limited-weight-gain diatribe of the medical profession. So I felt like I had some authority backing me up, which took a lot of the emotional sting out of the interaction and replaced it with a nice dose of self-righteous indignation.

restricting calories during pregnancy is not advised, now you have to eat for two, so eat whatever you like, just gestational diabetes and baby's diathesis are real things, so you won't eat anything causing that anyway, my sisters were not good with eating, so we had problems to make them eat

This is another reason that there should be no such thing as a male OB/GYN*.

This is ridiculous.

Competency and caring having nothing to do with gender.

44: "No male OBGYNs" is ridiculous and sexist and all that. Absolutely.

But saying that competence and caring, in the context of a situation where socially created gender issues interact strongly with the relevant medical issues, have nothing to do with gender is also kind of off-base. The gender of the practitioner seems very likely to me to affect the way they deal with issues like recommended weight gain and dietary/exercise restrictions.

my brother was a tad under 11lbs when he was born

I was 10 pounds, eight ounces. Also, 15-pounders don't even rule the roost.

I expect misc.kids. pregnancy is still going. It had mostly sane people on it when I used to read it. Misc.kids.breastfeeding was excellent too.

Just to add in a bit more anecdotal data, to give yet more feel for a normal range: I started off at about 130lb, and gained about 60 pounds with each of my first three pregnancies. The first two times I lost it again by the time the babies were about 9 months, without doing anything. Third time I stuck around 155. Think I went up to about the same weight the fourth time too (and I don't think I was particularly grotesque), and then went back down to 155 again for a while.

Healthy eating in pregnancy is pretty much the same as healthy eating when not pregnant. (Having said that, I lived on chocolate chip muffins for months of mine .... ) You're clearly ridiculously healthy, for fucks sake.

s/b have

Granted, I am biased on this issue, but I have been around a lot of ob/gyn doctors and nurses, and midwives too. There is a wide speculum of types of ob/gyns.

Some are like drill sergeants, with no nurturing. Others are like Dead-head hippies, going with the flow. Gender is simply not a great predictor of how the doctor or nurse will be.

and I don't think I was particularly grotesque

You're not fooling anybody by linking to pictures of Ogged, asilon.

a wide speculum

Best typo ever.

The gender of the practitioner seems very likely to me to affect the way they deal with issues like recommended weight gain and dietary/exercise restrictions.

Why? I fail to see any connection.

By the way heebie, have you come across the acronym NAK yet? Better practice typing one-handed if you don't want this baby to cut into your Unfogged time.

Best typo ever.

Horrible assumption. totally intentional. I was going to use cold in there somewhere too.

You're not fooling anybody by linking to pictures of Ogged, asilon.

That's no baby; that's my tumour!

asilon, your belly was HUGE!! But you were not!

Why? I fail to see any connection.

I don't believe you. You may not believe that the net result is that women are going to generically be better OBGYNs than men are, but I simply don't believe that you "fail to see" that women are, for social reasons, likely to have a different approach to interacting with another woman around, e.g., issues relating to weight gain and dietary restrictions than men are.

It's no fun having an argument with someone who's playing dumb.

Asilon is always one-upping people with that picture. Everyone else just slinks away.

60 pounds? Go for it. When are you going to get this close to two bills again?

Your obgine sounds like a twit. Next appointment, go in gnawing on a turkey leg in one hand and a ginormous chocolate bar in the other.

But saying that competence and caring, in the context of a situation where socially created gender issues interact strongly with the relevant medical issues, have nothing to do with gender is also kind of off-base. The gender of the practitioner seems very likely to me to affect the way they deal with issues like recommended weight gain and dietary/exercise restrictions.

Female Ob/Gyns are less likely to be influenced by"socially created gender issues"? Sorry, but will's right on this.

No, they're likely to be influenced differently than male OBGYNs are. Doesn't necessarily make them systematically better, but it seems weird to me to deny that there are likely to be gender-influenced patterns of behavior in this context.

Granted, NO men as OBGYNs is a wild overstatement. But:

Competency and caring having nothing to do with gender.

and especially

Gender is simply not a great predictor of how the doctor or nurse will be

Ain't so, in my experience or that of any of the moms and moms-to-be I know. Sure, a man can be just about anything, and there are undoubtedly plenty of skillful and sensitive and respectful man OBGYNs out there. But there are very good reasons to imagine that a man doctor might not be as in touch with the issues and experiences of pregnancy as a woman. Living in a body that can do the things you're discussing probably makes it a lot easier to understand and appreciate the experience and needs of the woman you're working with. That's a major handicap for the man doctor (and his patient) to overcome, and I don't think it's sexist to say so.

But the point at issue isn't whether male and female obgyns will have different behaviors, but whether one will have better behavior than the other with respect to this specific thing. There are plenty of women more than willing to judge other women about their weight and I'm sure some of them are obstetricians.

Cliff Huxtable was an excellent ob-gyn.

Doesn't necessarily make them systematically better, but it seems weird to me to deny that there are likely to be gender-influenced patterns of behavior in this context.

What patterns are you expecting? That men are more likely to perceive weight gain as problematic? That women are more likely to be understanding?

Female Ob/Gyns are less likely to be influenced by"socially created gender issues"? Sorry, but will's right on this

No, not less influenced, but influenced for the better not for the worse. In addition to the irreducible biological bits I mention above, there are definitely cultural aspects to how men and women relate to each other and to pregnancy as a concept and an experience. These suggest women are more likely to be prepared to deal well with the doctor's role than men will be.

multiple, omni-directional pwnage.

But there are very good reasons to imagine that a man doctor might not be as in touch with the issues and experiences of pregnancy as a woman. Living in a body that can do the things you're discussing probably makes it a lot easier to understand and appreciate the experience and needs of the woman you're working with.

Yeah, uh, I was so willing to buy into this line of thinking -- until the FEMALE ob resident berated me for yelling too much during delivery.

...and 65 was me. I'm not very good at this, am I?

55 - Will, the thing I was most worried about was having a 6 pound baby and being left with the enormous belly. But she was rather large too, thank goodness.

No, not less influenced, but influenced for the better not for the worse. In addition to the irreducible biological bits I mention above, there are definitely cultural aspects to how men and women relate to each other and to pregnancy as a concept and an experience. These suggest women are more likely to be prepared to deal well with the doctor's role than men will be.

So now, women are better doctors?

Women are kinder to other women than men are? More compassionate?

LB, you are simply wrong.

62: What I was reacting to was "nothing to do with gender". Being judgmental about weight isn't a simple yes/no behavior, it's going to be expressed in a way that's affected by the judger's gender as well. And the manner in which it's expressed is going to affect how the patient receives it as well. Dismissing the idea that the OBGYN's gender has anything at all to do with the interaction seems way off base to me.

68 - right, well, that does suck. I'm sorry. But just as a sensitive, well-informed and generally brilliant man OB doesn't prove Will's point, a crappy woman OB doesn't disprove mine.

competence and caring, in the context of a situation where socially created gender issues interact strongly with the relevant medical issues, have nothing to do with gender is also kind of off-base. The gender of the practitioner seems very likely to me to affect the way they deal with issues like recommended weight gain and dietary/exercise restrictions.

So now you are saying that it is simply different approaches, not better?

And please tell me what kind of ob/gyn is the best? Because your preference will be Di's, and asilon's, and heebie's, etc??

70: You know, Will, it's kind of peculiar of you to quote someone else, rephrase that quote in terms that I've specifically disagreed with, and close your comment by saying that I'm wrong. I may be wrong, but I'm not sure how I'm supposed to respond substantively to 70.

Will, that quote was me not LB. And what I said was pretty explicitly NOT that women were better doctors, or more compassionate etc (although some might be able to argue this). My point was that pregnancy and birth are things that women can experience and men cannot, so it is reasonable to imagine that a medical expert who could (and maybe has) experienced it may be better able to discuss it than one who couldn't.

But just as a sensitive, well-informed and generally brilliant man OB doesn't prove Will's point, a crappy woman OB doesn't disprove mine.

But I am not the one asserting that gender is determinative of competency and caring. You are.

I apologize for incorrect attribution. Now we can debate the word pecular perhaps? Because I was way off base attributing it to LB?

76: These arguments always turn into "You made the absolute claim. I can find a counterexample, so I win!" "No, you made the absolute claim. I can find the counterexample, so I win!"

Can we just stipulate that anyone who made an absolute always/never kind of claim was wrong?

the word pecular

This still seems to be something you think I said, but I'm not clear what you're referring to other than my use of the word "peculiar" in 74.

so it is reasonable to imagine that a medical expert who could (and maybe has) experienced it may be better able to discuss it than one who couldn't.

Certainly, they might. Also, if they have had a baby and their experience was the same as your experience.

But, this issue doesn't occur in a vacuum.

But, this issue doesn't occur in a vacuum.

Unless, of course, you attend the Dyson Clinic.

71: So your point is simply that gender of the doctor will have some impact on the way he or she approaches a patient? This seems pretty meaningless. I mean, whether or not they had a happy childhood is going to affect how they express things. Whether they had good instructors in med school. Whether they got into a fight/had amazing sex with their partner that morning will have an influence. Will wasn't claiming that gender has no influence on the lives of doctors, but that gender is a relatively useless means of predicting whether or not a given doctor is going to be compassionate and caring.

72: Well, no. But nor do anecdotes about how great your friends etc. found their female doctors prove LB's point.

Actually, I did not, nor did LB I think, argue that gender was determinative of competency or caring. I restated my argument above, so I won't go through it again, but I thought it was fairly clearly about what kind of experience a doctor can draw on, in a way that will contribute to their interactions with a patient. If you're reading an absolute determinist argument into anything being said here, no wonder you're so (apparently) upset; but I don't think it's there.

Can we just stipulate that anyone who made an absolute always/never kind of claim was wrong?

Always wrong?

84: Curses, foiled again.

Yes. LB, I thought you said it. Thus, I attributed it to you. Not such a great leap. Then, I found it out was not you. Now, I do not think you said it.

Remember, "obstetrician" literally means "someone who gets in the way". Oudemia will back me up.

Now that I'm on the downhill side of 40, all I want is a doctor with very thin fingers.

Maybe you should take up smoking. I hear it's supposed to help w/ weight gain.

Will wasn't claiming that gender has no influence on the lives of doctors, but that gender is a relatively useless means of predicting whether or not a given doctor is going to be compassionate and caring.

My second sums my thoughts up nicely. If only Hamilton had such a good second...

I got lectured this morning by the ob-gyn for excessive weight gain, and now I'm excessively irritated and defensive-feeling. "Average weight gain at 21 weeks is five pounds!" he said.

Just tell him to fuck off and refuse point blank to be weighed. They won't force you. If you get any backchat, tell him "If you want to know how big the baby is, then the most accurate way to do that is to measure my belly."

The gender stuff is kind of beside the point: it's more a matter of professional dynamics. You have a PhD in Math, right? You're smarter and better-educated than your OB and he'll just have to deal with it.

82: Well, more than that. A man being a judgmental asshole about your weight is often going to do it differently than a woman will. I can perfectly well see someone entering into a professional relationship with someone who is going to be in a position to be an asshole about their weight thinking about what kinds of judgmentalism are going to bother them more.

86: I'm really not trying to piss you off here; I honestly thought your 77 was still looking for a response from me.

A man being a judgmental asshole about your weight is often going to do it differently than a woman will. I can perfectly well see someone entering into a professional relationship with someone who is going to be in a position to be an asshole about their weight thinking about what kinds of judgmentalism are going to bother them more.

really? So, you, and the other women here will approach this topic uniformly the same way, and the men will all approach it uniformly the same way?

I don't think so. Overly simplistic and not predictive.

Remember, "obstetrician" literally means "someone who gets in the way".

Damn, I was sure it had something to do with fruit.

I'm not pissed. But, I do want to rage a little to give heebie some rage-company. BTW, where is that darn rage bunny??!?!?

These arguments always turn into "You made the absolute claim. I can find a counterexample, so I win!" "No, you made the absolute claim. I can find the counterexample, so I win!"

Actually, I think the claim is still wrong if it's being framed in terms of "more likely" rather than absolute. Which is indeed how your 45 and Marichiweu's comments read. You seem to have backtracked to simply taking the position that gender influences doctors, but not in any predictable ways -- which is an unobjectionable claim, but not one really responsive to will's point.

Yes, Will argued that gender was useless as a predictor of competency or caring (right? I lost the quote). While that may or may not be true of medical professionals in general, my argument is that it may in fact be a useful predictor for the childbirth domain for the reasons I outlined. Not because the man doctors lack competence or caring as such, but they lack access to a very relevant and valuable piece of experience.

And true, my collection of anecdotes is not necessarily better evidence than Di's individual anecdote, but these stories do add up. I suspect that if we were to do some kind of systematic survey it might tend in my direction. But I don't mean to brush off your experience, Di, and I'm sorry if I seemed to be doing so.

Me: often going to do it differently than a woman will

You: uniformly the same way

Will, you just restated my position to take all the caveats out of it, and then rejected it as too simplistic. Sure, it's too simplistic once you oversimplify it.

I'm not saying much here. I opened by agreeing with you that drumming all the male OBGYN's out of the profession was sexist and ridiculous. But there are gendered patterns to how people tend to behave in our society, and it's not crazy or sexist of me to think that those are likely to have a real effect on how male and female OBGYNs deal with their patients, given that it's a context that brings gender issues to the forefront. I can see someone presumptively preferring dealing with a male OBGYN, all other things being equal, or the reverse.

I just jumped in when you said gender of the provider had "nothing" to do with the care they delivered. That still seems to me to be very unrealistic.

97: I think my 99 responds to this as well, and I think if you look back at my 45, you'll see that I've been taking the same position all along.

Yeah, I think I'm sticking with my position. "Overly simplistic," perhaps, but the fact that a thing is not always or uniformly true doesn't mean it might not tend to be true more often than not, and that this tendency might be worth considering. That's what "predictor" means - a variable that will predict the appearance of another variable more often than not.

And again, I'd refer you to my actual reason for arguing this way - I'm not trying to make a "women are more caring" argument. One could study this issue in a quantitative fashion (men doctors versus women doctors, caring and competency rated on a Likert scale), and it wouldn't speak to what I'm saying.

Are you, Will or Di, saying that having a body that can experience pregnancy is totally irrelevant to how a doctor will deal with a pregnant patient? Because that's what you'd have to argue to respond to my claims.

Not because the man doctors lack competence or caring as such, but they lack access to a very relevant and valuable piece of experience.

Consider, however, that women's experiences -- particularly in this realm -- vary widely. The fact that a male ob necessarily has never had the experience of pregnancy and childbirth may, as a result, be advantageous if his recognition of his lack of experience translates into being less likely to presume he knows exactly what experience you are having. A woman who has had a relatively painless pregnancy/childbirth may well overvalue her own experience, believing it to be more representative than it really is. Personally, I'd prefer to have the doc who has no idea what I'm dealing with but is willing to listen to what I have to say about it. (Well, not *no* idea...)

Better to look at comparative variation rather than gender variation within countries. Caring or uncaring, male or female, your typical U.S. OB will weigh their patients like cows every visit; your French equivalent will be even more of a weight-gain fascist (but for different and of course perfectly rational reasons) but will also encourage you to drink while warning you repeatedly about the constant threat of toxoplasmosis and the dangers to the fetus of any physical exercise more intense than taking a drag on a cigarette; your Aussie OB will not give a shit about weight gain but will write you up confinement certificates; in parts of Asia your caring or uncaring, male or female medical staff and relatives will trap you in your home (or, preferably, your bed) for a month after the birth and forbid you from washing or combing your hair; and so on.

99: It's the reference to gendered patterns that I am wholly unconvinced by and which is, I think, will's objection as well. This really is suggesting there is some semi-uniform way women vs. men deal with pregnancy issues (even if you are allowing for outliers). But you still aren't telling us what you believe those patterns to be.

forbid you from washing or combing your hair

?

LB:

You are trying to argue that female obgyns are naturally better without arguing it. You cannot have it both ways. Either their gender makes them better or it doesnt.

Pick.

forbid you from washing or combing your hair

Seriously. Because of the dangers of illness.

but these stories do add up. I suspect that if we were to do some kind of systematic survey it might tend in my direction.

Not surprisingly, I disagree with you completely.

And you still need to define what "better" means. Or do all women like the same kind of ob/gyn?

107 -- Riiiiight... I can see how the not washing would protect your from germs...

107 -- Riiiiight... I can see how the not washing would protect your from germs...

Exactly. It's perfectly rational.

Heebie, you need to get more obstreperous with your obstetrician.

102 - that's a good point. My only argument would be that the if:
if his recognition of his lack of experience translates into being less likely to presume he knows exactly what experience you are having./

is a pretty huge if. A lot of patient experience in every domain suggests that doctors in general definitely do not tend [like my tentative language?] to not-presume in this fashion - I can dig out citations from medical anthropology/sociology if anyone wants justification for such a claim. It's entirely possible and undoubtedly happens all the time, as I've been caveating all along, but it's one more way in which the doctor-patient relationship might go wrong.

The converse, a woman doctor assuming she knows what you're experiencing because she has the same organs, I don't know. I feel like there's more to be said about that, but I suspect I'd have to start making arguments about how women are socialized to make assumptions about their experiences and knowledge and authority in very different ways than men are, and so on, and the discussion would turn into something very different. Maybe later.

Of course everyone should have the kind of obstetrician they're comfortable with, and they should be excellently trained and deeply insightful. On that note, let me say that it truly sucks that this university town has only one OBGYN office, the doctor there is decidedly not cool, and the nearest legal midwife or decent other OB is 90 minutes away. And with that, I must leave, to take my wife to the doctor believe it or not. My apologies for pushing any buttons that shouldn't have been pushed.

I feel like there's more to be said about that, but I suspect I'd have to start making arguments about how women are socialized to make assumptions about their experiences and knowledge and authority in very different ways than men are, and so on, and the discussion would turn into something very different.

As a woman in a male-dominated profession, I would argue back that socialization into professional norms not infrequently butts right up against gender norms, muddying them waters substantially.

(Oh, and no buttons pushed here Marichiweu -- just think you're wrong!)

Well, okay, one last thing. You're being kind of obnoxious, Will. LB is definitely arguing no such thing, and neither of us used the word "better" that you're challenging us to define, except inasmuch as I said women doctors might be able to better understand a patient's experience, which I think is clear enough. I apologize for starting something and running away, but now I'm imagining all the inaccurate things that will attributed to me in my absence...

And regarding patterns and uniformity. If you really believe that gender does not ever correlate with patterns of behavior in general or in this particular case, that's fine and I don't have the evidence handy to prove you wrong. But it's not an unreasonable thing to suggest, it's not a sexist thing to suggest, and the fact that every individual is unique and there's vast variety within each groups "women" and "men" in no way means that identifying patterns of difference is impossible.

114 - thanks Di, and I may well be. But I think I've pissed off Will a little.

And my grammer sux in 115. But now I'm leaving for real.

the fact that every individual is unique and there's vast variety within each groups "women" and "men" in no way means that identifying patterns of difference is impossible.

No, it certainly doesn't. The problem here is that vague references are being made to "patterns" without actually identifying or substantiating them.

Now go to the doctor, Marichiweu!

female obgyns are naturally culturally better

But. While this may be true (I'm agnostic on the question) there are good reasons we call this belief sexist and deprecate it. It's wrong to assume that a particular individual shares the common traits of their group - it deprives them of autonomy, and agency. So choosing a OB on the basis of gender is politically incorrect

106:

You are trying to argue that female obgyns are naturally better without arguing it.

Nope.

You cannot have it both ways.

Not trying to.

Either their gender makes them better or it doesnt.

If you say so.

I'm perfectly happy to say that you can't tell from gender alone whether a male or female OBGYN will be a preferable provider for any given patient, but I don't think that advances the conversation at all.

So choosing a OB on the basis of gender is politically incorrect

Not just politically incorrect. If you are sorting based on gender because you believe a woman will be more sensitive but don't make any other effort to assess the sensitivity of your doctor, you've defeated your own purpose. (Me, I didn't pick the female ob resident who yelled at me; I just lucked into her because the male family practice doc I had picked didn't show up on time. So 6 of one, half dozen of the other... )

My wife actually had gestational diabetes during her pregnancy (heroically controlled by diet); to alleviate the irritation I felt that the physicians and their magical numbers, I went to the local medical school library and looked up the standard textbooks for OB. (some of them are on Google Books, BTW)

I think what is irritating is these hard and fast cutoffs for blood sugar, etc. (e.g. 150 = bad, 149 = fine) and acting like patients (my wife, a RN) are complete and total morons who could not possibly grok medical concepts, uncertainty, etc.

Anyway, the real difference is between young OB-Gyns and old ones.

(Ducks.)

You rang?

29: My brother was 11 lbs 15 oz. My mother is 5'1". Rounder than she was tall during the pregnancy.

But I think I've pissed off Will a little.

Not in the least.

The real difference is between an ob/gyn who fits your needs and one who does not.

the fact that every individual is unique and there's vast variety within each groups "women" and "men" in no way means that identifying patterns of difference is impossible.

When you have identified that pattern of difference, please let me know.

Can we just stipulate that anyone who made an absolute always/never kind of claim was wrong?

Uh, that would have been me. Sorry!

Of course I immediately followed up with a counterexample. I win the argument with myself!

FWIW, I simply don't see how it's honestly controversial that a female doctor will be better equipped to deal (as a complete package) with female anatomies than a male doctor. However much you want to ascribe doctoring to technical knowledge accessible to anyone, there is inevitably a portion of doctoring that involves literal empathy. Even the best possible male obgyn (and I would nominate Kai's deliverer, who is also a trusted colleague of our beloved [female] family doctor) can't understand exactly what a pregnant woman is experiencing in the way that a female obgyn who has given birth can.

"You know how-"
"No, but I've heard that before."

A good, empathetic male doctor can be about as good an obgyn as a good, empathetic female doctor. But I think that the female obgyn will always have an advantage, however small (I believe the canonical phrase is, "Would you hire a mechanic who can't drive?").

As for the specific issue of bedside manner, as H-G dealt with, I would be sorely tempted to go with the generalization that women - for reasons of socialization, per Deborah Tannen - are more likely to act empathetically, ceteris paribus. It may be an effect at the margins - 40% of male doctors are dicks, and 38% of females are - but I'm pretty sure it's there. Add in pregnancy issues, with the infamous hormones, and I think that whatever general effect is there is magnified. I think (and AB agrees*) that I was one hell of a supportive husband/birthing partner, and as understanding as possible, but I would never barge into a conversation among mothers and imagine that I got it on the same level they did.

* And actually, so does our doctor and the doula

Better to have a female OBGYN. With all that Oxytocin floating around, the dad wants to be the only male available for the hormonal reaction.

Ever see a hormone? Heard one.

FWIW, I simply don't see how it's honestly controversial that a female doctor will be better equipped to deal (as a complete package) with female anatomies than a male doctor.

Do you think it equally uncontroversial that a female urologist cannot be as well equipped "as a complete package" ?

jroth: your numbers for dickish doctors of both genders are way low. I think the med school process screens more for ambition & arrogance than for intelligence or ability. (Although warm hearted brainiacs like read and Dr. Oops do get through) Its a systematic public health problem, really.

One may have reasons for choosing a female obgyn other than anything having to do with her. Like Di was saying in another thread about therapy, one can have a male therapist who could be really great, but because you've got a block about telling men things, you're not going to get much done in therapy. With an obgyn, I'm guessing you want to have someone you trust won't respond to your questions and anxieties by refusing you your right to your experience. Even if your obgyn wouldn't do this, if you've got a thing about men to the point that you wouldn't feel comfortable sharing those details, that's a problem.

No, it's not every man's fault that a lot of women assume men won't care about their fears and anxieties, but I wouldn't expect a man to feel totally comfortable going to a female urologist either. If your experiences of raising personal concerns or worries to a heterosexual partner has been dismissive, it's hard to deal with that w/r/t intimate doctoring issues.

can't understand exactly what a pregnant woman is experiencing in the way that a female obgyn who has given birth can.

Okay, for one this changes the discussion from male vs. female docs to docs who have and have not given birth.

Further, the fact that I have given birth doesn't equip me to understand a wide variety of other women's experiences. I didn't have back labor. In fact, my labor was very short. I thank God I can't understand what my BFF was experiencing when the epidural wore off during labor. Or my SIL's 26 hour labor. Or gestational diabetes or preeclampsia. Most of my friends who've given birth can't really understand worrying about not gaining enough weight, the way I did.

If the issue is ability to empathize, then it's important to note -- as beaten quite thoroughly to death by not one but two marriage counselors -- that empathy is NOT about comparing someone else's experiences to your own.

some names you can call your obstetrician

If you are sorting based on gender because you believe a woman will be more sensitive but don't make any other effort to assess the sensitivity of your doctor, you've defeated your own purpose.

Well, obviously. But if I only had one bite at the apple, I'd use the gender heuristic (although, as NPH notes, age is another heuristic - I'd be hard pressed to pick between a young male obgyn and an old female - medical culture has changed a lot over the years, and I prefer the newer approach).

If I were picking for a basketball team, I'd lean towards the taller players, even though Michael Jordan wasn't tall for a basketball player.

PS - Everyone we know who uses the local Midwife Center gushes over this one midwife, who is, of course, a male. Life is funny like that.

Aside: In my experience, the selection bias on med students by personality type is much higher magnitude than gender shifts.

131: And yes, that's a defense of sexism in certain cases. I have a right to be sexist about the person who pokes around in my vagina. I'd far rather have a dickish female gyn (all of mine have been total assholes) than even a nice male gyn.

but I wouldn't expect a man to feel totally comfortable going to a female urologist either

Not surprisingly. I know I wouldn't really like the experience. Thus far, a woman asking to see my penis has been a cause for joy; I'd rather not muddy the emotional waters.

I think my own issue about gynecologists is that they're all really bossy and nosy. I can handle a woman being bossy and nosy at me; if a man did it, I'd be outraged. I have this really loose trigger ready for paternalism. Deep-seated thing, very nasty.

Do you think it equally uncontroversial that a female urologist cannot be as well equipped "as a complete package" ?

For dealing with my ureter, sure. I'm pretty sure urologists don't specialize by gender, so someone is just guessing using their extensive technical knowledge with one group or the other anyway. But if I went to our family doctor and said, "You know how sometimes when you have an erection it feels like X?," she would say, "No, I don't." She'd still be able to treat me (or direct me to the right specialist), presumably, but it would be based on abstraction and observation, not empathy and direct experience.

And before someone says it, I don't think oncologists should have cancer first - but it wouldn't surprise me if cancer patients tend to find oncologists who have been treated for cancer to be, on average, a bit more empathetic.

PS - Do you like how I've single-handedly revived the great Unfogged tradition of gender argumentation? Do you think we can take this one to 500?

There, there, AWB, don't worry your pretty little head about such things.

Aside: In my experience, the selection bias on med students by personality type is much higher magnitude than gender shifts.

Do you think Obama's UHC plan will include a Myers-Briggs breakdown when you choose your primary care physician?

like read and Dr. Oops do get through
ooh, thank you, but how i can be compared with Dr. Oops
there is a saying that one becomes a real doc when one binds the hundredth patient's jaw (to avoid its dropping due to rigor mortis)
have to count 80 more to be called that, but fortunately i'm out of the business for now

134: A midhusband?

137: It's amazing how many of PMP's sexual encounters have included the phrase "turn your head and cough."

No, it's not every man's fault that a lot of women assume men won't care about their fears and anxieties, but I wouldn't expect a man to feel totally comfortable going to a female urologist either.

That is the way that you feel, AWB. You have the right to feel more comfortable with a woman.

Does that mean that all women or even a majority feel more comfortable with another woman as an ob/gyn?

No.

I'm not convinced that having the anatomy helps a doctor understand pregnancy/gynaecological problems. I've had both male and female OB/GYNs - none of the female ones were mothers, so their "experience" of pregnancy was hypothetical, at best. The doctor who listened to me and subsequently diagnosed what was wrong with me was male. Perhaps, male/female socialisation in this culture skews males toward not listening as well as females, in the paying attention and believing that the patient is recounting factual information sense. Perhaps female doctors are less likely to see themselves as gods in white coats. But it does boil down to the individual doctor, when all is said and done.

there is a saying that one becomes a real doc when one binds the hundredth patient's jaw

Yeah, but it's only used by oral surgeons.

(It does sound slightly more uplifting than experienced doctors just saying "shit happens" to the newbies)

"Male-midwife" is the term used in Tristram Shandy when Sterne is pwning this entire conversation.

I thought it was "man-midwife". And to be pretentious, the 'wife' part of the word refers to the patient, not the practitioner, so there's no need for a gendered form.

not empathy and direct experience.

Again, genuine empathy is not based in direct experience.

Okay, for one this changes the discussion from male vs. female docs to docs who have and have not given birth.

Well I started this mess, dammit, so I think I get to define terms. Or at least to say where I think the crucial difference is. To stir up another well-stirred shitpot, I'd rather ask childrearing questions of a ped with kids than one without.

If the issue is ability to empathize, then it's important to note -- as beaten quite thoroughly to death by not one but two marriage counselors -- that empathy is NOT about comparing someone else's experiences to your own.

2 things: first, I've never heard of a pregnant woman saying, "Oh, this is exactly like a lot of pre-pregnancy experiences I've had." While every pregnancy is a unique snowflake, they're all snowflakes, not raindrops, or whatever the hell would fit in the metaphor. An ectopic pregnancy is more like a hippie homebirth than it is like not being pregnant. Second, my focus is on the pre-labor/delivery aspects of pregnancy doctoring. Labor & delivery, as done in a hospital, are procedures for which a technical familiarity is paramount. But a pregnancy checkup is primarily touchy-feely in a way that elevates empathy - the technical aspects are secondary (for most pregnancies), and the important thing is to get a sense of how the pregnancy is going. There's no diagnostic tool that blinks red, yellow, or green to indicate how things are; the doctor relies primarily on conversation.

If I were picking for a basketball team, I'd lean towards the taller players, even though Michael Jordan wasn't tall for a basketball player.

But isn't the whole point that you're wrong here? If you're talking about picking relatively taller people out of the general population, that's going to be a good idea, but once you're restricting yourself to the universe of professional basketball players (trained doctors), selecting only the tallest players (female ob/gyns) isn't going to be helpful at all.

Do you think Obama's UHC plan will include a Myers-Briggs breakdown when you choose your primary care physician?

Won't help much, if you believe Myers-Briggs, they're highly clustered in a couple of types. It's an interesting sub culture.

It's amazing how many of PMP's sexual encounters have included the phrase "turn your head and cough."

Not to mention the furrowed brow and "Hmm... that's not good."

148: OMG, you're right. I'm teaching that part tomorrow, too. Very sad.

Again, genuine empathy is not based in direct experience.

Good, I wanted to talk more about this. [Analogy alert]

When I meet with clients and potential clients, I often talk about previous projects I've done. It's not because I think that every house should look like mine, or that every restaurant should be like one that I've done. It's a way to explore the client's issues, using my direct experiences as a launching point.

Further: when talking specifically about kitchen remodels, my experience as a fairly dedicated home cook gives me huge advantages in working with clients towards their solution. I'm not trying to impose my preferences - I don't prefer an open kitchen, but many others do, for instance - but I'm approaching their situation from a place of practical, visceral understanding. A kitchen, to me, is not a work triangle the area of which should not exceed 15 square feet. It is a place to cook, and even for a cook who works very differently than I do, I understand their goals in a way that my ex-boss who isn't especially adept with the microwave can't. I refuse to believe for a moment that this doesn't make me a better kitchen designer.

Also, do doctors really hassle patients about their weight proper, rather than underlying problems like high cholesterol or high blood pressure? Because weight itself isn't a medical condition.

Ha! If only! My doctor was very stern at my checkup a few weeks ago about me being right on the border of the 'heavy' classification on the BMI chart. I'm sure she meant well, and I also know I'm not fat, and that BMI is a non-useful measure in all kinds of ways. But that didn't stop me from being really upset for several hours.

(FTR, I have incredibly healthy blood pressure and cholesterol levels.)

Pondering my choices of doctors, in general:

Several of them are gay males, and are mostly younger than I am, but my primary doc is my age. Some are heterosexual males. Some are female. My gynaecologist is twelve. [Well, OK, in her late 20s, but she looks twelve.] My neurologist is a black woman in her 60s, with a PhD and an MD, who gave me a great pound cake recipe. I have an Iranian haemotologist [hawt!] and and Iranian renal doctor [sweet and caring man, who sat with me in the hospital and held my hand, but not hawt.] My knee surgeon is also hawt!, tho' not Iranian. [It's fun to watch the nurses interact with/talk about the hawt doctors.] My quondam cardiologist told me I reminded him of his mother in her youth, then told me I didn't need to see him anymore because, well, there's nothing wrong with my heart. [Never tell the ER doctor that your chest hurts without emphasising that it's because you've been sicking up for the past three hours. You will end up being sent off for cardiac evaluation.] I cannot pronounce the name of the infectious diseases locum I saw briefly in the hospital. She had to stand across the room because her perfume made me sneeze.

I've found that good doctors - competent people who don't think they're gods, who listen - come in all sexes and colours and orientations. Yeah, it's the individual.

155: Sure, and a male ob can draw on all the other patients (kitchens) he's cared for (designed). The advantage you have in enjoying cooking is less analogous, in my mind, to possessing a uterus and more to really being passionate about the female body, pregnancy, childbirth.

But isn't the whole point that you're wrong here? If you're talking about picking relatively taller people out of the general population, that's going to be a good idea, but once you're restricting yourself to the universe of professional basketball players (trained doctors), selecting only the tallest players (female ob/gyns) isn't going to be helpful at all.

This is interesting. I have to run out, and I'll think about it a bit more.

My one semi-immediate response is that a lot of obgyns don't have good bedside manner - the difference between the best (AB's) and worst (H-G's) is a lot bigger than the difference between the best and worst NBA players. If my priority is a nice obgyn with a good bedside manner, I'm still going to use sex as a heuristic, because I still think that there's at least some tendency in that direction. Now, a better heuristic would probably be to ask around the Midwife Center - my claim is weak, I won't deny.

156: Ugh. I'm overweight-but-not-obese on BMI, which is the category shown to be most likely to outlive everyone else. I have very low bad cholesterol, perfect blood pressure (finally, after a lifetime of terrifyingly low BP), a strong immune system, high energy, strong muscles, etc. And yet! Weight cannot come up with doctors without that pitying, "Now you know you should be watching your weight, right?"

The best was when I came to my bitchy German gynecologist nurse practitioner to tell her I was reacting badly to birth control. I listed a bunch of symptoms, including nausea, depression, vertigo, low sex drive, bad skin, and some weight gain, to which she impatiently responded, "Have you tried eating less?"

I kind of agree with 158, and kind of don't. My point is that the abstract experience that comes from designing lots of kitchens is qualitatively different from the experience that comes from being a designer who works in a kitchen. Indeed, my ex-boss has probably designed more kitchens than I have (he's been in practice since I was 3), but I've no doubt I'm a better kitchen designer. I guess I would suggest that "being passionate about the female body, pregnancy, childbirth" is more analogous to enjoying eating as a qual for designing kitchens (it isn't one). But this is why we shouldn't analogize.

I'm just not sure how you can tell if your obgyn is passionate about the female body, pregnancy, childbirth - I mean, theoretically they all are.

a lot of obgynsMDs don't have good bedside manner

primarily because it is not emphasized or selected for, and in many med schools not really trained for... to some degree arguably trained against.

156: Ha! If only! My doctor was very stern at my checkup a few weeks ago about me being right on the border of the 'heavy' classification on the BMI chart.

My experience as well from several doctors. Most outrageous was the guy who harassed me relentlessly when I was at a nice post-30 years old low weight*. I twas the first thing I thought of when i read heebie's post. I have subsequently gained a number of stones in protest against his treatment of me. Ha!

*I am in fact very big-boned and heavily-muscled...... really.

perfect blood pressure (finally, after a lifetime of terrifyingly low BP)

Watch that trendline!

ob/gyn is a difficult area because it requires surgical skills and a bedside manner that fits with your needs. Finding both is difficult.

For some women, they want someone to take charge and be direct. For other women, that doesn't work. They want a doctor to simply get out of their way.

Some ob/gyns rush to c-sections. Others are willing for you to wait it out.

It is so individualized that gender simply isnt a good predictor, unless like AWB, you are simply more comfortable with one gender more than the other.

164: I will, but I'm not at risk. It leveled off a few years ago. For some reason, it was like 80/50 before I became a vegetarian at 16 and has settled at the perfect mark since then. Being in control of my own nutrition since leaving home has had marked improvement on my health in a lot of ways. I don't pass out whenever I stand up anymore, for one thing.

ob/gyn is a difficult area because it requires surgical skills and a bedside manner that fits with your needs. Finding both is difficult.

The doctor plus doula combo seems like a very good idea for this reason.

Being in control of my own nutrition since leaving home has had marked improvement on my health in a lot of ways.

I would suspect poisoning if I were you.

unless like AWB, you are simply more comfortable with one gender more than the other.

It's also really not reasonable to discount the high percentage of women who have been victims of sexual abuse, or to wave away their concerns as "sexism against men." In my case, it's more about other kinds of abuse, but add people like me to the sexually abused, and you've got a ton of women who would really rather have a female gynecologist.

168 is probably right. I've suspected Munchausen's-by-Proxy for a long time. It just doesn't make sense that I was as sickly as I was, especially as a little child, and then now am one of the healthiest adults I know. (My mom still wistfully talks about how "delicate" my health was, and how she never expected that I would live to adulthood. Thanks, mom.)

169: It's okay -- there are also women like me who prefer male gynecologists.

170: Yikes! I was mostly kidding. Next time you're home, maybe you should feign some grave illness.

156, 160: I feel so incredibly lucky--I just had to start with a new doctor, and she's a young perky type that I (jumping to conclusions!) thought was going to be all over me about my weight.

I was delighted to find that she noted it on my chart without saying anything to me about it, and then just recommended we do a blood work-up (fine by me!). When all cholesterol, triglycerides, blood sugar, thyroid and everything came back normal, she was like well, looks like we don't need to worry.

So awesome.

there are also women like me who prefer male gynecologists

Di's a showoff.

Di's a showoff.

Or a big weirdo, maybe. Something.

I assume everyone has seen this, but it's relevant.

It's also really not reasonable to discount the high percentage of women who have been victims of sexual abuse, or to wave away their concerns as "sexism against men."

I never said it was sexist or not politically correct.

Just not very predictive.

176: Yeah, it's a pretty dysfunctional system in many ways.

177: It doesn't seem in any way surprising to me that many women would prefer female ob/gyns, or, due to such preferences, have better experiences with female ob/gyns. Maybe this is somehow rooted in sexism, but I can't make myself care much. But that's entirely different from the claim that female ob/gyns will be, on average, more sensitive/more compassionate/somehow otherwise objectively "better", all of which have been claimed in this thread.

Let's step aside from all the gender essentializing and get back to cultural analysis! Based solely on anecdotes, my doctor friends tell me that the OB/GYN rotation in med school is one of the last bastions of dickish, jerky, sexist old guys running the show (worse than surgeons, they say)--could this educational situation be responsible for selecting doctors (male or female) with less empathy or people skills? Also, perhaps male students would see these doctors as role models, while female students (as victims of their sexist jerkiness) might be more likely to chafe against their horrible ways. Just a thought.

female ob/gyns will be, on average, more sensitive/more compassionate/somehow otherwise objectively "better"

I wouldn't claim that. All my gyns have been assholes.

Ooh! I just remembered an anecdata point: a college friend's father was a doctor (either GP or obgyn - can't recall) who insisted, as a matter of settled medical fact, that PMS doesn't exist.

While there are women who don't suffer from PMS, I highly doubt that there's a single woman MD in the US who holds this position.

This is the sort of thing that colors my thinking.

who insisted, as a matter of settled medical fact, that PMS doesn't exist.

No wait! I recently read a really convincing piece on why this is a sound statement; shit, let me see if I can track this down.

Here it is - why PMS is a social construction. Which is a much less inflammatory statement than I'm sure the college friend's father was making; this doesn't contradict him being an asshole.

While there are women who don't suffer from PMS, I highly doubt that there's a single woman MD in the US who holds this position.

I've personally known four female ob/gyns and two female nurse practitioners who had zero tolerance for PMS. ZERO.

I've also known a bunch of female ob/gyns who worked up until the day before delivery and were back at work very quickly. Not much sympathy for long waits until return to work.

Does that mean that men are better ob/gyns? Of course not.

Its interesting how either asserting or denying the existence of PMS can be a patriarchal move.

This thread is lacking from pictures of Heebie. If we are truly going to assess her situation, we need pictures.

asilon did it!

||

This journal starts off "The article I read was actually about the female race." (Because they were bringing in current events about racism. I know it sounds like a middle school assignment. I get tired.) But I do like "the female race".

|>

188: But I'm at school!

Will, they just didn't accept your claim that you had PMS.

heterosexuality = miscegenation

192 to 189

190: Don't they have photocopiers?

194: That made me laugh.

Actually, it's a xerox machine/scanner that sends the image directly to your school inbox. It's practically begging for this. But I'd get all embarrassed.

But I'd get all embarrassed.

Feature!

The important thing about PMS is that everyone experiences it differently. Of course people in less supportive environments may feel the effects of hormonal changes more intensely. And different people react differently to hormonal shifts. (If you tell women that everyone gets fucked up by birth control, that's a patriarchal move, just as it's a patriarchal move to tell women they're making shit up if they react badly to birth control.) PMS isn't even predictable from month to month for the same person. And just because it is a social construct (which it obviously is--see every dickish "Must be that time of the month" comment ever) doesn't mean it's not also a real experience.

Its a social construct! Just like the credit crisis!

You could also say that pain is a social construct, since sometimes you feel it more when you expect to or are thinking about it, rather than when you don't or aren't.

Kobe gets PMS twice a month.

I don't think pain and PMS are social constructs in the same way. People across every culture have pain, but not (apparently) PMS.

Fuck your Ob/Gyn. I gained 65 lbs during pregnancy, and lost it all within two months b/c of breastfeeding. *And* I was eating a pound of chocolate and a half gallon of whole milk every goddamn day during those two months, as well. *And* I had morning sickness for seven months but gained anyway.

I hate your ob/gyn.

189: It was clearly about Hesiod, who writes of the "race and tribes of women."

In fact, before pregnancy I weighed 150 lbs, more or less, and for several years afterwards I was down to about 117. And now I'm hovering around 140. Tell your objin how statistics work, and also that maybe if he (?) ate better he might not be so freaking pissy all the time.

Pain is a really great place to study the interaction of social construction and physical causation, because both are clearly going on.

Valarie Hardcaste's *Myth of Pain* is a pretty good book on the subject. It was definitely a fun read, but I had issues with its underlying thesis.

Oh, for Christ's sake, you're pregnant. Your body is trying to make another person. Tell the doctor to go bunny up a stump.

I will now read the thread.

201: Also, pain is not just a cross-cultural phenomenon, it is a cross-species phenomenon. Series issues come up, though, with identifying pain in asocial animals.

The only hit for "go bunny up a stump" on all of the internet is another unfogged comment from Cala.

old, vestigial, college-age part of my brain who thinks its a great idea to start restricting calories

God, that's why doctors like this piss me off. Like, they're *doctors*. They should *know* that eating disorders are a big issue for women's health. But noooooooo, they have to get all uptight about the number on the goddamn scale.

Fuck your Ob/Gyn.

That's terrible advice, B.

finally, after a lifetime of terrifyingly low BP

Yeah. Seems like my blood pressure is usually around 90/60. I loooooove salt.

Anyway, no way could heebie sweet-talk her doc into the mommy-and-daddy dance now that she's morbidly obese.

go bunny up a stump.

Hmm, this one is new to me.

AND!! (Clearly I have ISSUES about the whole "advice"-to-pregnant-ladies thing. Grr.) In re. male vs. female ob/gyns, mine was a mtf transsexual (a rather famous one, as it turns out). And while she was definitely doctorish in terms of giving statistics and monitoring everything like crazy, she was also able to say things like "generally we advise x because of y, but there's no evidence that z" or "the evidence that z happens is inconclusive" and so on. In short, the whole sushi/bacon/raw cheese/sugar/candy/hairdye/alcohol advice is all about making blanket recommendations that do not, in fact, apply across the board so you know, it's not like pregnant women lose the capacity for personal judgment and risk assessment.

Grr.

212: Eliminated by bullet point #2 on his "patients I won't sleep with" list.

210: That occurred to me but I left it because it's so much terser than "beat your objinn with a baseball bat." And clearly, given the wordiness and number of comments I've left in the last fifteen minutes, I care a great deal about conciseness.

As far as the female OB/GYN debate goes, I stumble in only to note that many of these arguments against male doctors would seem to work against nullagravida female objines (or worse, against female doctors in general treating men for problems with their naughty bits), and we don't normally think it a requirement or even desirable trait in a doctor that she has personally experienced the operation, infection, or condition in question.

Our (female) OB/GYN, who was a very caring and wonderful doctor in her 30s, told us that it's increasingly rare for male medical students to become OB/GYNs, because of a perception that male OB/GYNs are at a strong disadvantage in the marketplace. According to her, plenty of practices won't hire male OB/GYNs because it's seen as bad for business, which means that men who want to go into the specialty are increasingly rare.

No idea whether or not this is actually true, but it made sense to me.

Wait, you're not supposed to eat BACON (????) when you're pregnant?

Apparently you shouldn't eat bacon because..it's bad for you?

"In recent years, the level of nitrates contained in processed foods has decreased, and is considered safe for pregnant women. In fact, nitrates are used as a preservative in meats, often making the meat safer than it would be otherwise, from a bacterial safety standpoint. However, I would suggest that you avoid them whenever possible, as foods containing nitrates, such as preserved meats like hot dogs and bacon, are not good nutritional choices for pregnant women because of their high sodium and fat content."

You can get nitrate/nitrite-free bacon.

220: Well, yeah, that's what makes all the prohibitions so enraging. The big pregnancy book, What To Expect When You're Expecting, refers to its recommendations as the "Best-Odds Diet", and talks about really thinking, if you're going to eat something racy and exciting like a bagel made with white flour, about whether that bite of food you're going to put in your mouth is the very best you could give your baby. Based on no particular evidence that eating whatever the hell you want, barring particular health problems or something actively poisonous, is going to do a developing fetus a bit of harm. But fucking around with telling pregnant women what they're allowed to do is harmless and fun.

221: You can, but you don't really need to.

222: I loathe that book with all the loathing I am capable of. If I were ever to meet the author, I might very well do something that could land me in jail.

The big pregnancy book, What To Expect When You're Expecting

When I met my wife she was working on her book "What To Expect When You're Expecting a Porsche" a tale of thirtysomething never marrieds with disposable income. Never published. (Never written, truth be told).

222 is a little strong. E.g., Listeriosis is a real concern and a reason why pregnant women might want to avoid sushi, blue cheeses or certain kinds of pates. That said, What to Expect When You're Expecting super sucks.

I loathe that book with all the loathing I am capable of.

Maybe this is more your style.

225: You're not more likely to get anything from sushi while pregnant than you are while not-pregnant. And I've never gotten sick from eating sushi, so. And I believe all cheese in the US has to be pasturized anyway.

226: You're trying to make me turn into the Hulk, aren't you?

This Obgyn gave me a copy of What To Expect on my first visit! Yay!

E.g., Listeriosis is a real concern and a reason why pregnant women might want to avoid sushi, blue cheeses or certain kinds of pates.

Might, but those dietary restrictions don't seem terribly necessary in other countries -- the risk of listeriosis may be non-zero, but it's not big.

You're not more likely to get anything from sushi while pregnant than you are while not-pregnant.

Yes you are.

I'm not a doctor at all, but I don't think that 227 is quite right, or at least not what I was told when I pressed our very good OB/Gyn on this issue extensively (I really distrust medical propoganda, and really like sushi). That is, there are a decent number of bacterial illnesses that an adult body can fend off without exhibiting symptoms but that can have serious or deadly effects on an in utero newborn. So, it's better to exercise even more caution than usual in eating raw foods (not to mention the mercury issue that can come up with fish generally). Hopefully someone more knowledgeable can come along to save me from wading in to a medical debate, but that's my understanding.

The reviews of the book in 226 are a hoot.

231 obviously pwnd by 230.

CDC says there are 2,500 cases of listeriosis each year, about 30% during pregnancy. Odds greater than being struck by lightning, but are they greater than being struck by an oncoming car? I don't have time to look it up.

i recalled this danger too
cats
sorry, i know how H-G loves her cats
sure maybe she knows already about this and takes precautions

I ate sushi practically every damn day during my last trimester and PK isn't dead, so.

233, no it wasn't, you actually wrote sentences and had personal experience.

I am not a woman or any other sort of person who is treated patronizingly by doctors, but I get annoyed at the presumption that all medical advice is either patronizing, or being spread by profit-seeking fearmongers, or only relevant on a population level and therefore not relevant to anyone.

What happens is, people do valid medical research, and then the relevance and significance of that medical research gets exaggerated and misinterpreted by the press and by people selling quick fixes for possibly nonexistent problems.

But the medical research still exists, and still means something, whether or not it gets exaggerated and misinterpreted. The job of the doctor is to be objective when looking at the accumulated knowledge, and decide what is the best course of action for an individual person. But even if the doctor gives you the same recommendation that she gives virtually everyone else, that doesn't mean she isn't viewing you as an individual.

There are a lot of things that are equally good for just about everyone to do, as far as we know. If every middle-aged person on earth took an aspirin every couple of days, even when healthy, there would be less heart disease. If every pregnant woman avoided chilled raw foods likely to contain bacteria, there would be a lot less of a couple dangerous infections.

A lot of doctors, if they aren't jaded, are constantly resisting the impulse to give lots of slightly useful but probably annoying tips to their patients. These tips are generally platitudes. Doing cardiovascular exercise a couple times a week is good for nearly everyone.

But it's especially hard to resist the impulse to give lots of advice to a pregnant woman. The first two trimesters of life are a uniquely critical time in the development of a person. And there's actually a deadline, after which the advice will no longer be useful, so it seems like the patient would be more likely to follow the advice since it is not advice that will be equally valid one, five, ten, twenty, thirty years down the road. It's time-sensitive.

Every time someone says "H-G" I think they're talking about Lovecraft.

Despite that there's not a famous "H. G. Lovecraft".

But it's especially hard to resist the impulse to give lots of advice to a pregnant woman. The first two trimesters of life are a uniquely critical time in the development of a person.

Right, but so much of the advice really is bullshit, and intrusive bullshit. I snapped at W. Breeze above about 'refined sugar', not just because I was being W-lfs-nian about the definition of the term, but because the vagueness means that it's not medical advice. Some women become unable to regulate their sugar levels during pregnancy, and if they're getting proper prenatal care they'll find that out and get advice on adjusting their diets to compensate, which is going to involve regulating their carbohydrate intake, including both simple and complex carbohydrates.

If gestational diabetes isn't a problem for you, on the other hand, having a candy bar isn't doing your fetus a blessed bit of harm, refined sugar or no. But the busybody impulse is to take every half-remembered bit of nonsense and turn it into an imperative, because the comfort or wishes of the pregnant woman mean absolutely nothing compared to what anyone thinks offhand might be better for the fetus.

If every middle-aged person on earth took an aspirin every couple of days,

Except for those of us who would immediately suffer asthma attacks and have to be rushed to the hospital.

If the asthma attack killed you, that's one less person to get heart disease. Advantage, aspirin!

235: Read, cats are only a problem if infected. A pregnant woman can avoid most danger by not being the one to change the cat box.

242: By those standards, we should all take hemlock and eliminate the problem entirely. Starting , perhaps, with the current administration.

Re 242, now I KNOW that LB used to be a corporate-side litigator.

Hey, a dead patient is a stable patient.

I ate sushi practically every damn day during my last trimester and PK isn't dead

Sushi turns fetuses gay.

The tiny little internal Pride parades are a hoot.

237: The assumption isn't that all medical advice is patronizing. It is that blanket recommendations like "pregnant women shouldn't drink" are fine as blanket recommendations, but that the facts behind them suggest that, on a case-to-case basis, the reality is that women have to make judgment calls.

Is the risk of being one of those 2,500 cases of lysistrata so high that you are willing to avoid sushi? To me, 2,500 cases a year is not a substantive risk, given the number of pregnancies that happen every year, the fact that my pregnancy wasn't risky in any other way, that I don't have a compromised immune system, etc. And I liked sushi, and I knew a good inexpensive sushi place, so fuck it.

Also, it isn't an assumption, you know: having actually been a real live pregnant woman, it was my experience that it was pretty difficult to get doctors (let alone your average layman) to actually give you straight information about the risks and let you make up your own mind. Everyone wants to make the risk assessment for you and tell you how important those first few months/trimesters/pregnancy is to fetal development and the baby's life prospects, so why would you want to take *any* risk?!?!

Well, for the same reason I take risks in other areas of my life (and so do you). Because I can think for myself. My being pregnant doesn't erase that, or compel me to explain myself to you. (The rhetorical you.)

Is the risk of being one of those 2,500 cases of lysistrata so high that you are willing to avoid sushi?

Do you mean listeria? Or should this be in the Modern Love thread?

249 -- As a horny helot, I'm hoping that there are at least 2,500,000 cases of Lysistrata per year.

I ate sushi practically every damn day during my last trimester and PK isn't dead

Yet.

I take risks in other areas of my life

My wife wouldn't wear her seatbelt after it became uncomfortable because of her pregnancy. This was exponentially more risky than her glass of wine with dinner. Guess which one had more busybody dogooder intervention.

The job of the doctor is to be objective when looking at the accumulated knowledge, and decide what is the best course of action for an individual person. But even if the doctor gives you the same recommendation that she gives virtually everyone else, that doesn't mean she isn't viewing you as an individual.

No, the job of the doctor is not to decide what the best course of action is for an individual person. The job of the doctor is to know the research and give you advice and, if asked for more information, to tell you what the advice is based on. No one is paying doctors to think for them.

Right. Because one is about shameful self-indulgence and the other isn't.

(Also, of course, once she's pregnant enough that the seat-belt is uncomfortable, the risk associated with the glass of wine has dropped from very low to pretty much nonexistent.)

2,500 cases of lysistrata is so awesome.

250: I'm so not-worried about that damn disease that I don't even bother to learn its name.

253: Yeah, exactly. Shit, it's more dangerous to drive while pregnant even *with* a seatbelt than it is to eat sushi.

No one is paying doctors to think for them.

I think that's flatly untrue. Which is a large part of the reason why people who are interested in thinking for themselves have such trouble finding doctors willing to go along.

pwned agin. dammit!

Is the risk of being one of those 2,500 cases of lysistrata

Both Mr. B and the boyfriend weep at the diagnosis. There will be no joy in Mudville tonight.

in Mudville tonight

That's not what she calls it.

Infection by whateverit's called is less common than death by suffocation, aka choking. Pregnant women shouldn't be on liquid diets! Then they wouldn't gain weight *or* choke to death. Think of how many babies that would save.

B, I don't think "lysistrata" was the word you were looking for.

That's not what she calls it.

I defer to your superior knowledge and experience in these matters, Apo.

260: Actually my point is that I'm *not* afraid of catching that disease, so.

As soon as I finish suing the dead cat house people, I'm going to file suit against all of you for sexual harassment.

Bitch, PhD is well known for her sexual support of the military industrial complex. It is her lysistrata prevention program.

dead cat house people

Famous blogger runs amok at The Bunny Ranch. Film at 11.

suing the dead cat house

This conjures up images of zombie hookers...

@ 266:
They really won't return the money? Bummer. Well I hope for you the DCHP are still liquid or that they find some other sucker who in turn will have to sue them when you're done with them.
Is your real estate agent helpful or not?

A pregnant woman can avoid most danger by not being the one to change the cat box.

Somehow the chore division in my house is that I do the dishes all the time, and fi empties the litter box periodically. I don't mind, but it does occur to me that once she's properly knocked up, there will be no "division" of chores.

once she's properly knocked up

Y'all getting the improper ones out of the way first?

Whether or not there's joy in Mudville, there's never any conception.

City of Mudville, land of ... Ectopia!

The doctor would also advise you to wear your seatbelt when you drive, if he didn't think you knew that already.

No, the job of the doctor is not to decide what the best course of action is for an individual person. The job of the doctor is to know the research and give you advice and, if asked for more information, to tell you what the advice is based on. No one is paying doctors to think for them.

Knowing the research and figuring out its significance is a form of thinking, which we rely on doctors to do since it isn't our jobs. Doctors get paid to A) think for us, and B) carry out skilled physical labor. Some do nothing but B, and some do almost nothing but A.

I didn't mean to say that the doctor's job is to tell you what to do...definitely the doctor's job is to give you advice. But like it or not, she usually has an idea in her head of what you should do.

Then if you choose to do something else, she can respond by acting disappointed and figuring that you are ignorant or irrational, or by figuring that you know more about your condition than she's been able to learn. This might be the main thing that leads people to get a first impression that the doctor is either good or bad. And yet, a lot of doctors keep acting egotistical and superior and patronizing, even though it makes patients go elsewhere.

Also...and this is true, even though it's also a right-wing talking point...doctors' fear of malpractice lawsuits affects their behavior in a number of ways. Sometimes they will be absolutely convinced that the patient needs one important procedure, or drug, or test, and that this procedure is so obviously the right thing to do, from a medical point of view, that it would be malpractice to do anything else. But still, the patient has the choice of whether to do it or not.

And a frequent horror story is about the doctor who recommends a biopsy, the patient declines, the patient turns out to have a serious disease that went undetected, and sues for malpractice. Because the standard of care, with those symptoms, is to have a biopsy. In effect, the patient is blaming the doctor for not bullying him into doing something he didn't want to do.

I don't know how common this is, but doctors are definitely afraid of it, and personal injury lawyers don't particularly care whether it was the patient, or the doctor, who decided not to have a certain procedure done that later turned out to be important. If I was told by the doctor that I had 200 times the normal risk for throat cancer, but that was still only a 5% risk...and he recommended a CT scan, and I turned it down...and then I ended up having throat cancer...you better believe I would think "If only he'd taken the time to make the risks clearer to me, I would have decided to have the scan done."

Infection by whateverit's called is less common than death by suffocation, aka choking. Pregnant women shouldn't be on liquid diets! Then they wouldn't gain weight *or* choke to death. Think of how many babies that would save.

THE POINT IS, that pregnant women are at a much higher risk for lysistrata poisoning than non-pregnant women. This is why pregnant women are particularly told to avoid things that would lead to it, and nonpregnant women aren't.

It's no worse than noticing that someone has asthma, and advising them to be extra careful on the "Ozone Alert" days. Having one condition makes you more susceptible to another condition.

Sure, there are lots of other busybody things that can be ignored, but this one is valid.

270: They don't have the money; they're just refusing to sign the papers to let the escrow holder release it. They've offered to "split" it with us.

My realtor is being helpful, in that she's sure we're in the right and has tracked down the contract wording that says so and has consulted a broker etc. etc. The unhelpful part is that she's not a lawyer and she wants to send a letter of demand, and I'm refusing to put anything in writing until I've talked to a lawyer.

I don't really want to sue. I actually want to avoid going to court and would therefore rather not send a letter that might piss them off even more. But we need the money, b/c our mortgage agent is having hissies about cash on hand for closing, and we've made an offer on a house that's supposed to close on the 24th of Dec, and obviously we want to move before then, so we need that damn money to loosen up fast. So we might have to go to court, but I'm not doing that unless I know for a fact that we'll win, and even before filing I'd still rather have a lawyer send a polite letter letting them know that we can't be bluffed to see if that works. (And if they're not bluffing, and we really might not win, then I want to play ball and get back what we can rather than incurring court costs on top of the $5k, even if it means that this other house we want to buy falls through. Goddammit.)

like it or not, she usually has an idea in her head of what you should do.

That's fine. But it isn't okay, as a matter of professional behavior, to shame people or hector them.

It's no worse than noticing that someone has asthma, and advising them to be extra careful on the "Ozone Alert" days

No one is objecting to being "advised." We are objecting to the fact that, once the advice is offered, follow-up questions or decisions contrary to advice are answered with nagging about the Importance of the Baby, as if we didn't know that ourselves, what with only being the actual pregnant women and all.

THE POINT IS, that pregnant women are at a much higher risk for lysistrata poisoning than non-pregnant women. This is why pregnant women are particularly told to avoid things that would lead to it, and nonpregnant women aren't.

The other point is, that even the much higher risk is still awfully low. Saying that my risk of getting struck by lightning is twenty times more than yours is doesn't constitute much of a reason for me to stay indoors on cloudy days.

Medical advice is fine, so long as it's medical advice: your risk of X is Y out of 100,000 if you do Z. But that's not what books like WTEWYE are doing, and it's not what random busybodies handing out advice about not drinking at all and avoiding refined sugar are doing. It's possible to resent the general attitude while accepting the possibility of well-informed and motivated medical advice.

Right, and it's also possible to be irritated by medical "advice" when it blurs the line between research and the general attitude. Like the person who left the second comment in this thread seemed to be. Irritated, that is, not blurring the line between research and received truths under the rubric of defending the right of doctors to give medical advice.

Hi, just got here. The OB sounds like a complete dumbass, and you should ignore his hectoring on weight gain unless you feel like pointing out to him how he is making no sense at all. Carry on.

you should ignore his hectoring on weight gain unless you feel like pointing out to him how he is making no sense at all.

I've followed this thread not closely enough: has someone suggested telling the OB-GYN in question directly that his hectoring about weight gain is not constructive? I mean an actual talk along the lines of: While I appreciate your telling me the statistical averages, I'm registering what you're saying as criticism, as a suggestion that I'm going to become overly fat in this pregnancy, and I'd rather know that weight gains of my type, at this stage in the pregnancy, aren't extreme or excessive, because otherwise I feel you're pressuring me along gendered lines, as though I should worry more about my weight as a woman than about bearing a healthy child.

I've had fights, or talks, like this, with doctors before, and it's not easy or fun, but I've thought that it was worthwhile.

Heebie, I remember the weight lecture. Totally ridiculous. One nurse-midwife gave me a huge guilt trip (I mean, I left the office in tears...sniff) about how I was possibly jeopardizing my child by increasing the risk of (well, of what, exactly? this was after the glucose test and etc, no sign of gestational diabetes, no elevated heart rate, etc, etc). She thought my baby was over 10 pounds. Turns out he wasn't, though. He weighed in at 7 pounds 11 ounces pounds at birth: totally fine, normal/normative weight, completely healthy. In other words, the weight lecture was just a bunch of control-freak medico-moral management.

Also, many (probably most) women do not lose up to 20 pounds in the first trimester. What a bizarre expectation.

Also, that What to Expect (once a month you can have half a bagel for a special treat) book still makes my blood boil.

Hang in there, Heebie! If you're hungry, you eat. I mean, you're pregnant, for god's sake.

My baby was over ten pounds. And he was completely fine. Screw doctors who try to guilt trip pregnant women.

One of the great problems with giving advice as a doctor is that all you patients are so fucking different. There are patients that are smarter than me and comfortable with their insight, and I can have a reasonable discussion with them about various risks, what tests mean, etc. Then there are those dumber than a room full of rocks, and the best way to deal with them is to give simple, straight forward instructions without a lot of options. Of course, there are also cantankerous stupid patients who have caught the idea that all doctors are manipulative assholes and won't believe what I am telling them on principle, so I have to come up with a way to convince them to do something that is important without them thinking that I have manipulated them. (And if you don't think that paternalism is an important part of medicine, you don't understand my job.) There are those who have had truly bad experiences with bad doctors, and are suspicious for very good reason. And then there are all the rest of you.

I abuse my position in academic (?!!!) medicine shamelessly, by taking as much time as I need to figure out how much information each patient can handle, and will happily spend 45 minutes in a simple post-op clinic visit to make sure that the patient understands as much as they can, and that, if they don't want to do what I want them to, they are making an informed decision. Because I am loud, pushy, and somewhat dominant among my colleagues, nobody complains about the fact that I often see fewer patients than the others. At least not to my face. And yet, despite all of this, I often get it completely wrong. I confuse simple people unnecessarily, I oversimplify for patients who have much greater insight than I pick up on, and in an attempt to be perceptive and understanding I offend people who simply want the facts and to get out of the office.

OB/GYN's have one of the most difficult jobs in medicine, and I think transplant surgery is a cakewalk next to it. Women have been having babies since the beginning of time without any help. Pregnancy is a 'natural' process, and the outcome should be a normal baby. But any other outcome must have a reason, and in a (futile) attempt to control outcomes, we try to control the process. You have an extended and intense relationship with a doctor while you aren't sick, but you probably don't get to talk with her for any length of time because she has 20 other patients in the waiting room, and all she can do is try to prevent something that probably isn't going to happen anyway. So she gives advice based on the best information she has, which usually can't even differentiate between causality and association.

Heebie, if I may be so bold, you already know that you feel well, and it sounds like the pregnancy is going well. You all have the benefit of being way smarter than the average bear, and you know that, especially when dealing with something like pregnancy, the doctor's primary job is to catch bad things early. I have to say, that while your OB sounded like a jerk at first, when you asked him for more information he admitted that his statistics included a wide variety of patients, and that he didn't have good information about the subset of patients that you fall into. That doesn't change the fact that I wasn't there, so I don't know how much of a jerk he was, but he was honest about the limits of what he was telling you. If he is really an asshole, just take LB's advice and use him for the necessary tests, and talk to your doula for the rest of it. But if you tell him what is making you uncomfortable, he may surprise you and have a more in depth discussion about your concerns. Ask if he will correspond by email, as that will often give you more time to formulate both questions and answers.

Sorry about the rant. I was going to get into the whole gender thing too, but I think I have carpal tunnel syndrome. Hi everybody, and I hope I didn't say anything offensive.

read - I still remember the bus stop fondly, and am pleased every time you comment when I am lurking (which is pretty much daily.)

285 confirms once again the transitive property of good rants.

But if you tell him what is making you uncomfortable, he may surprise you and have a more in depth discussion about your concerns.

Yeah. Dr. Oops confirms, from a dr's perspective, what I was trying to say as well: tell the guy how you're responding to his information.

I'll throw something else out there along these general lines: we've talked a few times lately about the value of GPs, primary care physicians, as opposed to ditching them in favor of a combination of nurse practitioners and specialists. One of the things I've come to appreciate most about my GP is that over the years, she's learned enough about me that she's able to inform and discuss with me in a way that's pitched to my level of information and discernment.

Hi, Dr. Oops. We heart you, and most doctors, who by and large are very nice, responsible, concerned people. Also, universal health care for everyone, which needs to include half-hour appointments for everyone and no tedious paperwork!

A real doctor! I was just thinking about how there are thousands of lawyers on the internet, but doctors are all too busy to give their opinions for free.

Thanks, B. I heart you all back.

Actually, Nid (may I call you that?), it's hard to stop me once I get started. Although Beefo Meaty slowed me down a bit. Thank you, I think.

Oh, and transplant surgeons aren't real doctors. We just rearrange stuff.

The other point is, that even the much higher risk is still awfully low.

This is really important. E.g., when I went on birth control pills years ago I was worried about blood clots because it DOUBLES YOUR RISK. But, as my helpful objine pointed out, that's actually still a lower risk of blood clots than one has during pregnancy, i.e., not as scary as it sounds. Quite a lot of the recommendations during pregnancy are rather like this.

Not that I would recommend a sushi binge, or a wine habit, but, honestly, the fact that the recommendations vary so much by culture should be a big honking clue that we should take some of this with grains of salt, even if sodium intake levels should be watched during pregnancy.

And according to one of my doctor friends, there's not actually any research saying 'x amount of alcohol is safe; x+n is dangerous', because no fucking way a study like that could be done. So the recommendations are based mostly on seeing the effects of alcoholism on pregnant women and babies.

hi, Dr. Oops! me too remember the bus stop meeting with you, you are very beautiful, the silvery hair
i wish you would comment more often, it would be nice if you'd drop sometimes interesting medical trivia
i'm getting not able to study by myself anymore it seems, just start to read something professionally related immediately feel sleepy
nasakenai

Although Beefo Meaty slowed me down a bit.

Completely accidental. Rant more!

293 Absolutely true. When our Mom was pregnant with LB, she was told to have a glass of gin every day so she wouldn't go into premature labor. So, we exchanged the loss of the little one for the deformed monster that is always hanging around here. Still not sure if Mom made the right choice, frankly.

"That baby was 10 pounds 3 ounces. I'm glad I didn't stop smoking or drinking. Hell, I should have smoked and drank twice as much."

-- An Old Friend

I'm no ob-gyn quack, but my filmic experience has taught me that Miss Heeb's symptoms are indicative of bearing the Anti-Christ.

We've had frank conversations about other things that have bothered me - on the first appointment I confronted him about the tons of cosmetic surgery and lipo propaganda throughout the office. (They've actually removed the one big lipo poster in the waiting room, but I don't know that that had anything to do with me.)(The tvs in the examination rooms still show loops of lipo informercials when they're not being used for your ultrasound.)

especially when dealing with something like pregnancy, the doctor's primary job is to catch bad things early.

True. But weight gain in particular is an area where medical professionals quite often moralize innapropriately, and assign virtue, etc, to being slim. And being that slender = healthy in a lot of poorly phrased statements, it sounded to my overly sensitive self like there was something supposed to be great about losing weight due to excessive nausea in the first trimester.

Clearly, heebie should go to a Kobe/Gyn.

(The tvs in the examination rooms still show loops of lipo informercials when they're not being used for your ultrasound.)

I honestly had no idea you could even perform lipo on a fetus.

Just a hint to the proprietors: a healthy unfogged should have at least two active threads, even if one is the result of regurgitating arguments previously enjoyed. Perhaps the denizens thereof might be more comfortable discussing this than some potentially evil baby. Perhaps they prefer anything to ben's nonsense. Who can know, unless they are given a chance?

302: ask and you shall receive.

Well, clearly, that does sound weird. The lipo, that is. But as far as moralizing and virtue, I think you overstate the case when you refer to medical professionals. Not that some don't, but I think the majority of us realize the difficulty that patients have controlling their weight. I don't want to get into defending the medical community as a whole, but I do believe that in this case the societal pressures regarding weight, body image, etc are carried into the office by the patient as often as weight is used as a catch-all to blame a patient by the doctor. (Is that sentence even readable?) It is unfortunate, but weight is a marker for other potentially dangerous conditions, and often does merit discussion. Like any other marker, it needs to be put in perspective, but it shouldn't be off limits. No patient should be held to some artificial ideal weight, but unusual weight loss or gain can be a marker for other problems. Rapid or excessive weight gain during pregnancy is associated with gestational diabetes and probably should trigger a repeat glucose tolerance test, or at least a conversation. I think a lot of patients hear the moralizing even when the doctor means nothing of the sort. I can tell you that I used to approach those conversations so gingerly that it would often take a couple of tries before the patient knew what I was talking about.
If I am beating a dead horse, I apologize. Anyway, I do think that lipo advertisements in an OB/GYN office are extremely strange and actually somewhat cruel, so my guess is you are reading this particular doctor exactly right.

I'm all for beating dead horses, and against weight judgments. I used to be 5'9" and regularly 185, a normal programmer's build. I now find myself 5'8" and 165, by no virtue of my own. Explain that, stupid science.

fm, that's a perfectly normal effect of age related osteoporosis - how long ago did you turn 80?

No, the job of the doctor is not to decide what the best course of action is for an individual person. The job of the doctor is to know the research and give you advice and, if asked for more information, to tell you what the advice is based on.

I'm filing that one away for use next time you're defending some little classroom fascist teacher.

In unrelated news, I've had it anecdotally confirmed by three friends who are doctors that no way on earth would they trust a male gynaecologist unless they knew him very well. Because the point is that the medical profession doesn't just randomly assign male and female students to specialities; it lets them pick them. And as a result, a significant proportion of male gynaecologists fall into the category "really quite creepy". Apparently quite a few also fall into the category "too think for any other speciality", but I think that this was probably intraprofessional rivalry and prejudice.

Contrarianism is a wonderful thing. I'm now tempted to write an impassioned defense of the competence and character of male gynos generally.

I'm not going to, because come to think of it I don't know any particularly well, but I'd like to.

And happy birthday Dr. O!

I think a lot of patients hear the moralizing even when the doctor means nothing of the sort.

Entirely possible, but it's also the case that women in particular get doctors worried about their weight for their health at levels well beyond what's backed up by the evidence. My last physical showed a very healthy blood pressure, generally sexy bloodwork, and a BMI of 24. Three guesses as to the doctor's advice to me. (And, no, this isn't a sudden or drastic change in body type.)

My husband is a powerfully built but chubby man, well into "overweight" on the charts, and no doctor's ever said a thing. Anecdata, certainly, but not uncommon, and it's easy to see why the best intentions ("rapid weight gain is correlated with several risk factors during pregnancy") might not come through ("oh please, you are the sort that is worried because I've gained five pounds since I was 22. break me a fucking give."), especially given the rest of societal pressures.

But as far as moralizing and virtue, I think you overstate the case when you refer to medical professionals.

Yeah, I definitely was. I should have said "A good proportion of inappropriate comments by doctors focus on weight" not "A good proportion of doctors make innappropriate comments about weight".

Anyway, I do think that lipo advertisements in an OB/GYN office are extremely strange and actually somewhat cruel, so my guess is you are reading this particular doctor exactly right.

Which totally begs the question which I imagine everyone's wondered, "Heebie, why the hell don't you just change docs?" I made some half-hearted attempts at the beginning of the pregnancy at the other clinic in town, and met with a bizarrely user-unfriendly administrator, and then started having complications (which are all resolved now) and just sort of figured that I shouldn't switch horses midstream. And now that I've got a great doula who vouches for my doc's competency, if not bedside manner, I haven't reopened the issue.

I'm now tempted to write an impassioned defense of the competence and character of male gynos generally.

My anecdata set is sufficiently large to almost count as real data. IMX the female docs and nurses in the ob/gyn unit I worked in were much less sympathetic compared to the males. From what I could tell there was far more than a bit of the "I got through it, she got through it, you'll get through it, stop your bitching, bitch" attitude akin to initiations and boot camps.

As far as competence, that was a wash. They're all about the same under close supervision. It's how they slide on their own that makes for differences.

There's a wide variety of doctors, but a certain group of them are so ambitious and (sometimes) so successful that they have trouble sympathizing with losers. And sick people are losers. Past a certain point (helplessness, incontinence, etc.) even a sick doctor is a loser.

I just got back from a meeting with my pain management doctor where he actually came right out and asked me what I think we should do. Part of it is that last time around I was a bit of a pain in the ass with asking tons of questions and generally being assertive about my role in the whole treatment process, which I did deliberately since the previous visit (my first with him) had left me feeling like I just got my scheduled maintenance from the meat mechanic.

It's sucky that doctors visits require the social dominance dance in order to get best results, especially since they tend to occur when you feel like shit. Still, I've found that coming on strong, assertive, and confident makes a huge difference in the quality of care.

314.2 semi-pwned by 313

Happy birthday, Dr. Oops!

From what I could tell there was far more than a bit of the "I got through it, she got through it, you'll get through it, stop your bitching, bitch" attitude akin to initiations and boot camps.

This I can see. My midwife, who I adored, had a definite drill sergeant thing going on. That's an overstatement -- she certainly wasn't mean or rude like the horror who told Di to stop making noise. But there was a distinct tone of "You're perfectly healthy, and dramatic as this all may seem to you, I watch this happen five days a week and twice on Sunday. It's not going to kill you."

I was annoying Will above by saying that you can't dismiss gender of the provider as not a factor, while not coming right out and saying "I think women are better OBGYNs" but what I was saying is really what I think. While I don't think you can dismiss the effects of gender completely, I also genuinely don't think you can describe those effects in simple statements like "Women doctors are more empathetic and kinder" or have 'better' bedside manner generally.

This seems apropos:

Imagine sitting in a dark room all day, evaluating CT scans and other medical images on a computer screen but never actually seeing real patients. That's life for many radiologists.

But an intriguing Israeli study found adding photos of patients' faces to the file made these doctors more meticulous when looking at the X-rays. They reported more details and said they felt more empathy for patients who were otherwise strangers. [...]

The study involved 15 radiologists at Shaare Zedek Medical Center in Jerusalem and 318 patients who agreed to be photographed before undergoing CT scans. The color photos appeared automatically when the doctors opened the patients' computer files.

The study's focus was not on the ailment the scans were meant to evaluate, but rather on incidental findings that often show up on CT images, such as kidney cysts in patients scanned for suspected appendicitis. Doctors reported these extra findings in 81 scans when the photos were included.

Three months later, the doctors unknowingly viewed the same 81 scans, but without patients' photos. This time, the doctors failed to report 80 percent of the incidental findings.

That's absurd. My wife (athlete, dancer, and nutritionist specializing in maternal and child health) put on 50+ with kid #1 and close to that much with kid #2. She and the kids were perfectly healthy. She breastfed both and the weight came back off readily.

But saying that competence and caring, in the context of a situation where socially created gender issues interact strongly with the relevant medical issues, have nothing to do with gender is also kind of off-base. The gender of the practitioner seems very likely to me to affect the way they deal with issues like recommended weight gain and dietary/exercise restrictions.

Ok, LB, now I will really play dumb.

This statement is addressing "competence and caring."

So please explain how this statement is not suggesting that being a woman is "very likely" to make a woman more competent and/or caring.

Or were the two sentences not related?

40!
Thanks, LB and read. I would love to stay, but I have to go to clinic and make people feel badly about themselves. So empowering.

Will, let's start from the assumption that all the comments I made saying that you can't assume on the basis of gender alone that any female doctor is preferable to any male doctor for any given patient, or that all female doctors are 'better' than all male doctors, and so on can be taken at face value. I'm not just trying to evade you, those comments accurately state my beliefs.

I took "Competence and caring" to refer to all aspects of delivering patient care. Which, you know, isn't a simple, one-dimensional quality such that you can say that Doctor A has more competence and caring than Doctor B unless the many, many differences in delivering patient care you're going to run into all happen to come down in Doctor A's favor. In other words, rejecting your claim that gender of the provider can be categorically said to have nothing to do with competence and caring does not imply a claim that women can generally be found above men on the competence and caring scale.

Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors -- I'd just be very surprised if there weren't such areas. (Irrelevantly, I prefer female OBGYNs myself, out of modesty issues rather than anything that's really about the doctor. While I don't find getting a pelvic exam from a man traumatic or anything, it is weird enough for me that I find I don't ask questions or so forth in the same way I do with a female OBGYN.)

Specifically on the weight thing, I'd expect that, while there's probably a roughly similar percentage of real assholes, male or female, that hassling pregnant women about weight gain unnecessarily is going to pop up as a red flag more easily for women who have dealt with similar issues themselves than for men. I could be wrong about that, maybe there's no difference, and I could be wrong in the opposite direction, maybe women doctors are systematically more unpleasant about weight gain then men are. But women and men in our society have systematically different experiences around weight, and it would surprise me if those systematically different experiences didn't produce systematically different ways of relating to patients around that particular issue.

Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors

I think the stronger claim can be defended, simply on the basis that I think this assumption:

while there's probably a roughly similar percentage of real assholes, male or female

is potentially flawed. As I say, I have anecdata for a non-negligible number of male medical students every year who decide to specialise in gynaecology because (let's put this delicately) they have sexual hangups.

re: 323

It's taken me some years to get over sharing a flat with two medical students when I was an undergraduate. The whole '(collectively) medical students are a bunch of arseholes' cliché definitely seemed to have some truth to it.

I should say that we do have one regular real doctor here, which is Read. She shares Mongol folk remedies with us for fun, but as I understand she's trained in scientific medicine, with a Russian and Japanese slant.

It's possible that doctors are getting nicer as their relative compensation diminishes, since it isn't the best deal any more for people whose goals are primarily money and status.

A generation ago a well-connected MD-psychiatrist told me that most MDs become MDs to make their parents happy, and that if they were just greedy they'd go into the business world. In other words, there is still some distinction between money and status.

As I say, I have anecdata for a non-negligible number of male medical students every year who decide to specialise in gynaecology because (let's put this delicately) they have sexual hangups.

These men are all British, right?

I'm starting to wonder whether that cute nurse-practitioner who did my proctology exam wasn't abusing me in some way.

Anecdotally, my dad is also a physician, (although not a GP so I don't think people's weights come up much if it's not medically indicated.) Anyway, women's weight is one of the few areas where he's a total jackass, like calling nondescript adult women "blobs" in the course of a story where it's completely irrelevant what she looks like.

These men are all British, right?

I dunno about hist anecdata, but I've run into the same in the US.

since it isn't the best deal any more for people whose goals are primarily money and status.

It never was the best deal -- rather closest thing to a sure fire deal. In many areas, US MDs are clearly overcompensated, but if you factor the time in and debt load etc., many of the brighter ones would plausibly have done a lot better financially in business, sure.

I think public perception has changed enough that `community respect' doesn't interact nearly as strongly as it did a few generations ago.

326: no, British medical schools have students from all over the world.

Anecdatum: Compared to Oregon medical people, Wobegon medical people are much less vigilant in the nagging about alcoholism area. They know how much I drink, my liver functions are fine, and they haven't said a word. Around here I'm a lot closer to the baseline.

If there's anything to d2d's and soup's impression, I wonder if there's a vicious circle going on. There are a fair number of women who are going to prefer female gynos for reasons not closely connected to the individual quality of the doctor (trauma, modesty). Which is going to make gynecology a less attractive option for men who aren't really committed to being a gyno, rather than some other sort of doctor. And while not all men who are really committed to being gynos are going to be weirdos, you can see that if there's any significant number of weirdos, that process is going to concentrate them.

For a subject nation, Britain has excellent schools.

many of the brighter ones would plausibly have done a lot better financially in business, sure.

More of a crapshoot, though, don't you think? Medicine and law both have the quality that a book-smart student can pretty much count on a nicely UMC income. 'Business', on the other hand, is more individual path dependent, and less about academics. While the high end payoffs are much higher, the possible low end is more likely and less attractive.

The guy was, as I said, well-connected. He was comparing high-end medicine to high-end business. He wouldn't have started in the business world with a Mom n Pop restaurant.

For someone from an ordinary family with no connections and little wealth, medicine might be better.

The whole '(collectively) medical students are a bunch of arseholes' cliché definitely seemed to have some truth to it.

Aww. I hung out quite a bit with a med student when I was in law school whom I totally adored. They're not all bad!

re: 336

I very much liked my two flat-mates, too. But some of their friends (and one of my flat-mates for that matter) were very much a 'type'.

The US system is different is it not? Actual med students in the US will be older [having done a degree already]?

shares Mongol folk remedies
which are not only fun, but sometimes even pretty useful

I liked a fair number of the med students I knew through my job. They tend to be razor-sharp efficiency experts and pretty much detached from standard-average medium-achiever neighborhood folk, but a lot of them were non-predatory people with a considerable range of interests (which they were not able to follow up on the way they wished).

The US system is different is it not? Actual med students in the US will be older [having done a degree already]?

Oh, that's right. I forgot you guys do things differently. Yes, a first year med student will most likely be 21+.

In any case, Read, you are a real doctor -- one who has an interest in Mongol folk medicine.

When I started working at the medical school, women med students were a small minority and tended to dress very conservatively. By the time I left 26 years later, they were dressing stylishly and a lot of them were incredibly cute.

By that time I was agéd and they all looked terribly young to me. One year a group of entering students was ushered through, and I seriously thought that it was HS career day.

The US system is different is it not? Actual med students in the US will be older [having done a degree already]?

Yes it's different in that respect. However, taken as a whole med school students are on average very much a type. I think this is partially self selection, partially selection bias on the part of the schools.

Of course, there are a lot of excpetions.

More of a crapshoot, though, don't you think?

Absolutely. That's why I said it was the closest thing to a sure-fire bet. Much more so than law is my impression; once you actually get in to a school it's pretty hard not to finish (they will bend over pretty hard to help you once you are in), and with an MD you'll always have access to many reasonable and decent paying jobs). The variance seems much lower than law.

True, but a large part of that is that there don't really seem to be lousy med schools. Oh, some are more famous than others, but there's not a huge perceived quality difference between graduates of Harvard Med and graduates of NC State Med (if there is one) -- they're all in the same employment world.

Law school, on the other hand, the top tier doesn't have much to do with the lower tiers, employment opportunities-wise.

If you want an overweight kid, keep it up.

http://books.nap.edu/openbook.php?record_id=11817&page=59

The Danish cohort study discussed earlier reported a linear association of maternal gestational weight gain with offspring BMI that appears to be fairly consistent across ages (Schack-Nielsen et al., 2005). It is also associated with child gender, fetal growth, maternal age, sociodemographics and smoking. The authors report that they saw no interaction between maternal prepregnancy BMI and gestational weight gain. In a larger study of Israelis who were born in the 1970s, Seidman et al. (1996) indicated higher gestational weight gain was associated with an elevated odds ratio of offspring overweight. A study of over 1,000 children in Italy born in the 1970s and early 1980s found no association between gestational weight gain and child weight, although gestational weight gain was assessed retrospectively and by recall only (Maffeis et al., 1994). This is the only study to show an inverse association of gestational weight gain with BMI and percentage body fat.
A more recent study by Whitaker (2004) with a large population of children enrolled in the WIC program shows no obvious linear association of gestational weight gain with child overweight risk, and in fact suggests a J shape with a higher risk in the first quartile, lower in the second, and then perhaps increasing. Gestational weight gain here was obtained from birth certificates and was reported as net weight gain, not total weight gain, and was adjusted for maternal but not paternal BMI, smoking, sociodemographics, and fetal growth. The authors reported no interaction between BMI and gestational weight gain.
Oken described initial data analyzed from Project Viva, a long-term pregnancy and child cohort study with information on over 1,000 children, followed to age 3. In the study, maternal and child weight are very similar to current national estimates. These data suggest a linear association between maternal gestational weight gain and the risk of child overweight at age 3, child BMI score, and the sum of subscapular and triceps skinfolds. There was no association between gestational weight gain and the ratio of subscapular to triceps skinfolds, which is a measure of central obesity. Increased gestational weight gain was also associated with increase of systolic blood pressure, adjusted for maternal prepregnancy BMI, smoking, race/ethnicity, income, marital status, glucose tolerance during pregnancy, paternal BMI, child gender, gestation length, and breastfeeding duration. Final adjustment estimates remain statistically meaningful, suggesting that gestational weight gain has an independent effect on child overweight and child BMI at age 3. Looking at maternal weight gain (using IOM categories), compared with mothers who gained inadequate weight, mothers who gained both adequate and excessive weight had similar elevations in the child's BMI score.
Finally, Oken described one study that suggests the relationship between maternal gestational weight gain and child overweight risk seems to vary within different categories of maternal prepregnancy weight; it assumes a J shape among underweight mothers, a U shape among mothers with gestational weight gain less than 45 lbs., and a linear pattern at the highest weight gains (personal communication, A.J. Sharma, Centers for Disease Control and Prevention). The lowest risk of child overweight was seen in mothers who were underweight before pregnancy and gained less than 45 lbs. and the highest absolute risk of overweight was seen in mothers who were obese before pregnancy and gained 30 lbs. or more.

And btw. The doctor doesn't care if you're running three times a week. The doctor only cares about the outcome (weight gain). That's because this ISN'T some moral issue - but a medical issue.

NC State Med (if there is one)

Just a veterinary medicine program. Medical schools at Duke and UNC.

but there's not a huge perceived quality difference between graduates of Harvard Med and graduates of NC State Med (if there is one) -- they're all in the same employment world

I am not sure this is entirely true, it probably isn't quite as big a deal as in law. A friend of mine just graduated med school and she said it definitely helps get an interview if you come from a well regarded school as opposed to state med.

That's part of it, but another (and interconnected) part of it is that there is a chronic oversupply of law graduates in some broad sense, and the opposite with medicine. There isn't the same commingling of career paths. Part of that is the difference in sheer time and effort, sure, but part is the whole approach. The medicine world is much more in lockstep educationally, but part of that is the controlled access to jobs. Credential-wise, you can't typically do that much else with an MD, but the flip side of that is that there is a job for everyone (at the very least) in roughly the same pool, and it's known to be there for you when you start.

I've visited three male ob/gyns over the years, one French in France, one German in Germany, and one German on Park Ave.

The French OB was cranky, professional, and brusque: the whole procedure was a little humiliating, but then, it was a free clinic.

The German guy in Germany was recommended by a feminist academic colleague, and he was very very nice, took a lot of time with me, but did wax a little unnervingly poetic about the condition of my cervex, which he helpfully informed me was called the "mouth of the world" (I've forgotten the German phrase).

The German guy on Park Ave. was hideously expensive---it was a referral---and he was older, established, all that. THE DUDE ACTUALLY PATTED MY ASS. In an avuncular way, sure, but Jesus. After thinking about the visit a few days, I realised that I'd paid a lot of money for rather poor service, all things considered, and so I've stuck with Planned Parenthood and sharp funny female NPs since.

As I say, I have anecdata for a non-negligible number of male medical students every year who decide to specialise in gynaecology because (let's put this delicately) they have sexual hangups

Not necessarily "hangups".

Eric Stratton '63 - Gynecologist to the stars, Beverly Hills, CA

I am not sure this is entirely true,

Yes, it's not entirely true. But it is a vastly more even landscape than in law, and from what I can see working with the right people afterward can even things out more easily (in part because of the access problem, `highly regarded' seems more concentrated in law)

346: And thank you for a perfect example of someone being a controlling asshole based on a poor understanding of statistics with ambiguous implications.

Everyone go to Talking Points Memo when you have the time. He's got a string of about ten posts on the GAO's report on Paulson's bailout, and apparently it's been a disaster. After skimming, it looks as bad as I feared.

I think that in the US there is a real dichotomy wrt medical students. Those who 'know' they want to be doctors before they enter college will gravitate towards pre-med programs, which are basically large winnowing machines. They are pushed to be as competitive as possible, and are generally taught that success is measured by their GPA. So, while they may be older than their foreign counterparts, they have also been in a closed environment that selects for grade hustlers. Those of us who were fortunate enough to have been clueless for an extended period of time weren't exposed to that, and often had more time to interact with the real world. It isn't a clear cut division between the two groups, but I do think sometimes that 8 straight years of very competitive higher ed is not the best way to encourage compassion and understanding.

And on preview...
346
Holy crap. LB gets it completely right.

I would say more, but there is an angry patient family waiting for me. I may try to come back later, if I can.

Thank you from the bottom of my heart for #346, Adam, I will treasure it as a precious gem and link to it in any and all forthcoming "evidence based medicine" debates, roughly at the point where people accuse me of raising strawmen when I suggest that EBM cultists* often make wild, sweeping and highly prescriptive statements on the basis of very poor statistical evidence indeed, and are far too keen to help themselves to claims of "objectivity" when they do so.

* my quarrel is with the fanboys and wannabes, of course, rather than the sensible scientists, as it is in economics. As in economics, the question of whether it is the scientists or the fanboys who set the tenor of the field is an empirical one, and one on which I currently take no position.

One of my favorite MDs at my job was in a philosophy PhD program when she found that they didn't do Hegel any more, and decided to go to med school. Another was a published poet who had graduated from the Iowa MFA poetry program. Another had done anthropology research in Bhutan or thereabouts.

Some MDs were just barely able to get into med school by cheating, whereas others had a range of things they were capable of doing.

Looking at maternal weight gain (using IOM categories), compared with mothers who gained inadequate weight, mothers who gained both adequate and excessive weight had similar elevations in the child's BMI score.

Surely this is the relevant data point, not 'omg ur makin ur fetus fat.'

The doctor doesn't care if you're running three times a week

That's a shame, because there's all sorts of clinical research about how exercise during pregnancy is good for you, too.

356: Dsquared is polite and mild-mannered guy to a fault.

Of course, LB an others have noted that 346 displays "a poor understanding of statistics with ambiguous implications." To this, I would add a broader point. Risk of having an overweight kid? Really, that's the big, horrible outcome Mama Heebie is supposed to be scared of? That her kid might be -- egad! -- overweight? Heaven forfend!

We're talking like hillbillies you know. "The gummint ain't gonna tell me what I kin eat!"

I wonder if there's a vicious circle going on.

I am sure that there is. Perhaps you are perpetuating it?

So a man who wants to look at girl parts all day is a sexual weirdo, but a woman is not? Excellent logic people.

Male urologists are all gay too, right? And the female urologists are perverts?

Of course, nobody would go into ob/gyn because they can do both surgery and get to know their patients.

will, what's with the straw men?

So a man who wants to look at girl parts all day is a sexual weirdo, but a woman is not? Excellent logic people.

No, it's an inductive, empirical proposition, not one of deductive logic.

Male urologists are all gay too, right? And the female urologists are perverts?

OT, but this is the second time that you appear to be implying that only men urinate and it's just not true.

Do share your recipe for possum, JE.

Wait... I want to look at girl parts all day. Does that mean I'm probably a sexual weirdo?

Geez, Will, have I pissed you off personally or something? If I owe you an apology for something I've missed, tip me off to what's going on.

Otherwise, out of a series of comments going, essentially: d2d -- Anectodally, I wouldn't trust a male gyno, lots of them are sickos; Soup -- sounds about right to me; me -- if there's anything to that, I wonder if it might not be that other market forces tend to drive men out of the speciality unless they're strongly personally invested in it; how come mine was the one that seems to have really bothered you?

366: In your case, we have your posting history to rely on.

I used to have med student roommates, one male, two female. They were all pretty nice people, tho' the one [female] from a small town in Wisconsin was a pool shark.

I've noticed that the younger doctors I've seen lately seem a lot more grounded and personable than doctors I saw in my youth. And my hawt knee surgeon, in response to my muttering that I needed to lose weight before the joint replacement surgery, said 'Don't worry about it - hell, I go up and down all the time, myself, I know how hard it is'.

Anecdatally, my mom had a kinder bedside manner than my dad, but her compassion was wasted in the specialty she eventually chose.

A bit related to this topic is Dooce's discussion with her doctor re: staying on Prozac during pregnancy. [He says it's fine, many women take it during pregnancy with no ill effect on the baby.] She's awaiting the emails/comments condemning her as being A BAD PREGNANT LADY! It isn't only doctors who feel the need to dictate to pregnant women...

dsquared is talking but I am not listening! Women do not!

Interesting article from 2001:
http://www.obgyn.net/displayarticle.asp?page=/english/pubs/roberta/rr_4-19-97

LB: Why do you take my comments personally? I am not pissed at you personally. I dislike your argument, not you.

Also, if one male ob/gyn makes an inappropriate comment, does that mean that is a male thing? Does the same apply when a female ob/gyn makes a similar inappropriate comment.

Okay, if there's nothing special going on I'll figure that you're just having difficulty following what I said. Note the difference between: if there's any significant number of weirdos, that process is going to concentrate them and So a man who wants to look at girl parts all day is a sexual weirdo, .

Also, you were kind of urgent, in 320, about wanting a response to your questions, but don't seem to have been interested in my 322. Did that explain my position to your satisfaction, or is there anything else I can set out for you?

And my hawt knee surgeon, in response to my muttering that I needed to lose weight before the joint replacement surgery, said 'Don't worry about it - hell, I go up and down all the time, myself, I know how hard it is'.

I wonder if this was offered in the same light as some of Will's advice about when one should get married and how one should treat one's spouse.

Jammies ought to be glad Heebie's not from the Huichol Indian tribe: [via Weird Universe]

'During traditional childbirth, the father sits above his labouring wife on the roof of their hut. Ropes are tied around his testicles and his wife holds onto the other ends. Each time she feels a painful contraction, she tugs on the ropes so that her husband will share some of the pain of their child's entrance into the world.'

Anecdatally, my mom had a kinder bedside manner than my dad, but her compassion was wasted in the specialty she eventually chose.

I'm friends with a married doctor couple, the husband a psychiatrist and the wife a GP who was originally going to be an objine until she decided the crazy hours weren't worth it. He's a decent doctor, I'm sure, but she has a really amazing empathy combined with an ability to communicate concisely and respectfully. A couple of years ago she applied for some program to become an anesthesiologist, which seems like it would have been a tremendous waste of her skills in dealing with conscious people. She ended up not getting accepted to the program and now thinks it wouldn't have been a good idea.

On the other hand, I hear the potential for prescription drug abuse makes it all worthwhile.

I'll figure that you're just having difficulty following what I said.

I'm just glad that you aren't using that condescending attitude anymore, LB. I will try really, really hard to keep up with your comments next time.

First, when I said Excellent logic people. I was referring to more than just you. Thus, my comment about sexual weirdos was not just directed at you.

On multiple occasions, you have used the word "different" when you mean "better." Then, you try to say that you didn't imply "better." I've addressed you 322 in my prior comment. Perhaps you simply didnt want to read what I wrote, because I am certain that you have the capacity to read and understand what I wrote, even with my far inferior intellect.

I am still not pissed off though!!! stomps foot!

I've addressed you 322 in my prior comment.

You mean in 362? Sorry, I thought that was addressed solely to my 332. I don't understand the application to 322.

And I do apologize for being condescending. Your responses to my comments on this topic seem weirdly heated, non-responsive, and not directed at what I'm actually saying, and I'm having trouble with engaging in a manner that's polite but still makes clear that I don't understand what's going on with you -- trying to combine the two does come off condescendingly, and I'll try to work on my tone.

On multiple occasions, you have used the word "different" when you mean "better." Then, you try to say that you didn't imply "better."

(While we're talking about tone, it's really kind of hard to engage respectfully when you keep calling me a liar.) Nope. I've said different when I mean different. When you drill down into very specific aspects of patient care, like interactions relating to weight gain, I wouldn't be surprised if there weren't reasonably broad gender based patterns of difference that might be better or worse from the perspective of patients dealing with those issues, as I offered in 322. I could be wrong about the specifics there -- I wouldn't be surprised -- but I would be very surprised if there weren't any average gender differences that affect patient care.

So what does differences mean then?

Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors -- I'd just be very surprised if there weren't such areas. ..

Specifically on the weight thing, I'd expect that, while there's probably a roughly similar percentage of real assholes, male or female, that hassling pregnant women about weight gain unnecessarily is going to pop up as a red flag more easily for women who have dealt with similar issues themselves than for men. I could be wrong about that, maybe there's no difference, and I could be wrong in the opposite direction, maybe women doctors are systematically more unpleasant about weight gain then men are. But women and men in our society have systematically different experiences around weight, and it would surprise me if those systematically different experiences didn't produce systematically different ways of relating to patients around that particular issue.

So when you use the word "differences" in this comment, you didnt mean "better"?

Oh come on.

Are you asking for a definition of the word? I offered one possible difference in 322, and referred to it again in 381. Do you want more examples of ways in which male doctors might generally interact differently with patients than female doctors? Again, harking back to my 322: Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors -- I'd just be very surprised if there weren't such areas.

If you want, I can make up some guesses offhand, and you can tell me they're worthless because they're offhand guesses, but that doesn't seem like a really productive use of our time.

First, when I said Excellent logic people. I was referring to more than just you. things people didn't actually say.

So soup, dsquared was the only on indicating that many male ob/gyns were sexual weirdos?

LB, you just think there are differences, without any qualitative aspect?

384 crossed with 383: Okay, you did want to talk specifically about the weight gain thing.

Sure. On that specific issue, I'd expect that a female practitioner who isn't a huge asshole would be likely to be more sensitive about stressing out female patients on the topic of weight gain than a male practitioner (that is, we're putting real jerks to one side, and talking about average doctors), and that difference, if I'm right about it, is one where I think more women would prefer to deal with a more sensitive practitioner.

But as I said in 322 I'm not strongly committed to being right about that -- you could send out questionaires or something and find out. What I am strongly committed to is that I'd be really surprised if research into practitioner's attitudes towards and interactions with patients on various issues didn't show gendered patterns of difference.

370: Mom McQueen's specialty was autopsies, for those who didn't get the joke.

My dad had a matter-of-fact approach to medicine and could be pretty gruff. On the other hand, he didn't follow any health rules whatsoever, so he didn't nag people much. He'd tell them that quitting smoking was medically advised while puffing on a cigarette. (Two people have told me that story first hand.) His idea was that you run your body hard and take it into the mechanic if there's a problem.

387: By 'qualitative aspect' you mean better/worse? As I've said a number of times now, I don't have a lot of specific claims about differences I'm going to set up and defend. But I figure of the differences, if any, there are, some are going to be neither better or worse from the point of view of most patients, a fair number are going to be better from the point of view of some patients, and worse from the point of view of others (see, e.g., Di, who prefers male gynos, presumably because she perceives some gendered pattern of difference between male and female gynos), and some are going to be the sort of thing that most patients would agree on as better or worse.

Ok, so you did use "different" to mean "better."

Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors -- I'd just be very surprised if there weren't such areas.

And here, you didn't mean "better" when you wrote "differently"?

Wow. I feel foolish for having spent time on this topic.

Watching one litigator try to pin down another litigator is a blast.

Ok, so you did use "different" to mean "better."

No. I identified a particular difference where I thought female practitioners might be more likely to take a preferable approach. That's very different from using the word 'different' when I really mean 'better'.

And here, you didn't mean "better" when you wrote "differently"?

You betcha. If I'd meant 'better', I would have made that clear.

You seem to believe that I'm sneakily trying to argue that female OBGYNs are universally better than male OBGYNs without taking responsibility for it. Honestly, I'm not.

So soup, dsquared was the only on indicating that many male ob/gyns were sexual weirdos?

A tendency isn't a rule. Saying that out of the lets say couple hundredish MD's and med school students I've interacted with socially I've noticed a trend in specialty X is anectdata --- so it's neither a generalized claim. More importantly, even if this personal experience generalizes *perfectly* it is not a claim of the converse.

Even if the claim were stronger: "Every X I've met was Y" this is a fundamentally different thing than saying "If you're X, you must be Y". Pretending they're equivalent is either confused or dishonest.

393: Oh, man, anyone talking to a witness like this, either of us, would be a counterproductive idiot. This isn't professional litigation skills at all.

I want to switch the playing field a bit to understand the dispute better.

Will, would it be non-controversial if I were to assert that men and women in the US are sometimes observed to have different communication styles? That is, not that "All men do X and no women do it," but that uptalking, for example, is more likely to be done by women?

If so, do you think that those differences in style are minor enough that professional training (e.g. as an MD) will trump them all? That is, doctor-style communication is far more powerful than whether the doctor is male or female?

This is litigators running wild. Like alligators fighting.

Allitigators are all about arguing. Always. And airplanes.

396: of course it's not professional litigation skillz, but it's very characteristic superfine-splitting-of-hairs and reluctance-to-back-away-from-a-point-(even-when-warranted) and aggressive-edginess-even-when-everyone-claims-(truthfully)-not-to-be-upset.

Oh, and this:

I identified a particular difference where I thought female practitioners might be more likely to take a preferable approach. That's very different from using the word 'different' when I really mean 'better'.

Is pretty seriously unconvincing.

I identified a particular difference where I thought female practitioners might be more likely to take a preferable approach. That's very different from using the word 'different' when I really mean 'better'.

"Preferable" is very different from "better"?

I agree with you here, overall, but this is shaky.

Btwned

My husband is a powerfully built but chubby man, well into "overweight" on the charts, and no doctor's ever said a thing.

Just to counter one anecdote with another: a few years ago, I went to my GP because my knee hurt so much that I couldn't bend it fully. He'd previously expressed concern about my weight. (I'm also well into "overweight" on the charts, but not really anywhere near "powerfully built".) The nurse took my blood pressure, which was high, and my doctor started worrying about that and insisting that I start meds immediately. When I asked him about my knee (which was, after all, why I'd come in in the first place), his only response was "You're fat. Of course your knee hurts."

Turns out I had arthritis and ended up having almost 100cc of fluid drained from my knee. Thanks, doc.

It's like a thousand voices cried out "He has excellent penmanship" and were suddenly silenced.

You may be unconvinced, but I think I'm perfectly clear. 322 identified a particular difference (noting that I was guessing at it and it could either not exist or go the other way) in which I'd surmise that female doctors would be more likely to take an approach that their patients would find preferable. Saying that with respect to a particular difference I think female doctors are likely to be preferable is very different from saying that whenever I use the term 'different' I mean 'better'.

(And Brock? 'Unconvincing'? Do you mean 'your use of language is unclear' or was that a statement that 'Like Will, I too believe that you are dishonestly attempting to argue that women are universally better OBGYNs than men without taking responsibility for saying it outright'? Because if that's what you believe, I repeat yet again that I am not arguing that position. And apparently that my reputation for truthfulness around here is not what it could be.)

Will, would it be non-controversial if I were to assert that men and women in the US are sometimes observed to have different communication styles? That is, not that "All men do X and no women do it," but that uptalking, for example, is more likely to be done by women?

If so, do you think that those differences in style are minor enough that professional training (e.g. as an MD) will trump them all? That is, doctor-style communication is far more powerful than whether the doctor is male or female?

1. I find that I am more inclined to agree with you since I have seen your picture than I am with soup who I have never met.

2. I agree that men and women often have different communication skills. I also agree that professional training does not completely eliminate gender differences.

3. For the record, I am a trial lawyer, not a litigator. My spelling and punctuation wouldnt allow me to be a litigator. Plus, I cherish paper and cannot use it so indiscriminately.

401: It's not that preferable is that different from better (I'm sticking on 'better' because of the implication of objectivity). It's that because I identified a particular difference where I think female practitioners are likely to take a preferable approach, that doesn't imply that every time I say 'different' it's a coded way of saying 'better', which is what Will seems to believe.

1. I find that I am more inclined to agree with you since I have seen your picture than I am with soup who I have never met.

We're we disagreeing about something?

I've pointed out the strawmen you're engaging, but that's not the same thing at all.

407:

No. I just wanted you to stop evading your qualitative pronouncements under that guise that "different" did not mean qualitatively better.

We're we disagreeing about something?

I've pointed out the strawmen you're engaging, but that's not the same thing at all.

It is too! [insert 400 comments disputing the word "disagree"]

I agree that men and women often have different communication skills. I also agree that professional training does not completely eliminate gender differences.

Hrm. And yet 405 doesn't work for you? You still think LB* is making a broad claim that women are better OB/GYNs than men?

*Whose delightful visage you have not only beheld, but can visit again in the Flickr group anytime.

Okay. So when I say 'different', I mean 'different'. And when I talk about a specific difference, I make it clear, as I did in 322, when I see that difference as something that's generally going to be preferable to most patients. What comments of mine you think are evasive, I don't know.

Okay. So when I say 'different', I mean 'different'.

Whoa, let's not jump to conclusions here.

When I was tending rather seriously towards the anorexic , none of the doctors I visited for other things said a thing about my weight!

I'm not sure whether that bolsters anybody's argument.

LB: I don't think you're claiming women are universally better ob/gyns, nor do I think anyone has accused you of claiming that. I do think your comments in this thread suggest you think they are likely on average to be better (with plenty of individual counterexamples, of course). It seems odd that you refuse to claim this position, since it's perfectly defensible (several people in the thread have claimed it). Tell me, can you identify a particular difference where you think male ob/gyns would be more likely than female ob/gyns to take a preferable approach? If not, why doesn't that plus your 394 makes women more likely on average to be better?

Now, I don't have a lot of well sourced or thought out specific claims for areas in which I'm certain that female doctors will on average tend to interact with their patients differently than male doctors -- I'd just be very surprised if there weren't such areas. (Irrelevantly, I prefer female OBGYNs myself, out of modesty issues rather than anything that's really about the doctor. While I don't find getting a pelvic exam from a man traumatic or anything, it is weird enough for me that I find I don't ask questions or so forth in the same way I do with a female OBGYN.)

Ok fine. I give. LB's comment than female ob/gyn's are different/preferable than male ob/gyn's is limited to weight gain and dietary restrictions.

Other than that, she takes no position on gender differences.

I on the other hand will defend the proposition "female gynaecologists are less likely to be sex perverts than male gynaecologists" as a valid statistical claim, albeit one based on anecdata rather than rigorous sampling. I will withhold judgement on whether this makes them "better" or not because I am a scientist.

Brock: I don't think you're claiming women are universally better ob/gyns, nor do I think anyone has accused you of claiming that.

Will, in 106: You are trying to argue that female obgyns are naturally better without arguing it.

So, that's why I think that's what Will, at least, believes I'm arguing, and it's making me a little cranky.

I've got some half-assed guesses about how different patterns of gendered socialization are likely to affect interactions between doctors and patients, but nothing I'd really defend to the point of wanting to argue about it. So I'm not going to -- the fact that I have half-baked surmises doesn't require me to lay them out and defend them as if they were beliefs I was committed to.

What I've been arguing against throughout was Will's initial claim that gender of the practitioner had nothing to do with patient care, which seemed overstated and indefensible -- gender is going to play into any kind of highly socialized interaction like that.

Whose delightful visage you have not only beheld, but can visit again in the Flickr group anytime.

True. But she and her hubby hid from me all night. Unlike you, who I was able to trap into a long conversation.

417: Counterexample!

Other than that, she takes no position on gender differences.

Beyond that I would be very surprised if none that affect patient care exist.

There's a "universally" missing in one of those two quotes, LB. I think Will's been pretty clear that he's not accusing you of thinking every single male ob/gyn is worse than every single female ob/gyn, which is what you keep reacting against.

"female gynaecologists are less likely to be sex perverts than male gynaecologists" as a valid statistical claim

I agree with you, but aren't females also less likely to be sex perverts than males in the population at large?

You are trying to argue that female obgyns are naturally better without arguing it.

Naturally does not mean universally. In other words, they start off with an advantage.

What I've been arguing against throughout was Will's initial claim that gender of the practitioner had nothing to do with patient care, which seemed overstated and indefensible -- gender is going to play into any kind of highly socialized interaction like that.

This was my statement that you have argued against:

"Competency and caring having nothing to do with gender."

And I was responding to this comment: This is another reason that there should be no such thing as a male OB/GYN*.

Do you have a response to the last two sentences of 415, LB?

424: Yep, my response is in 418: I've got some half-assed guesses about how different patterns of gendered socialization are likely to affect interactions between doctors and patients, but nothing I'd really defend to the point of wanting to argue about it. So I'm not going to -- the fact that I have half-baked surmises doesn't require me to lay them out and defend them as if they were beliefs I was committed to.

It's not that preferable is that different from better (I'm sticking on 'better' because of the implication of objectivity). It's that because I identified a particular difference where I think female practitioners are likely to take a preferable approach, that doesn't imply that every time I say 'different' it's a coded way of saying 'better', which is what Will seems to believe.

No, I think he believe that you are arguing that female ob/gyns are better on some particular dimension and has been frustrated by your refusal to acknowledge what you are, in fact, saying. In terms of sensitivity on weight issues, you have expressly said that you believe women are likely to have a "preferable" style, which is close enough to "better" that it's really been pointless if that semantic distinction was the sole sticking point.

I don't think Will has ever once in this thread attributed to you a position that women ob/gyns are all-around better people more worthy of admission to heaven. He has been calling you on precisely what you are saying -- that you believe women are "better" or "preferable" on a very specific dimension. You seem to have kept assuming he just didn't get what you were saying rather than actually addressing his argument about exactly what you are saying.

And, from my luxurious perch as an appellate guru who mostly reads such exchanges only on the sterile paper of a transcript, I can't help but notice that (in comment threads, litigation, etc.) that the surest way to get someone to refuse to admit any given point is to aggressively persist in badgering them to admit a given point.

423: Way back in 322, I explained what I understood you to mean by "competency and caring" :I took "Competence and caring" to refer to all aspects of delivering patient care. Which, you know, isn't a simple, one-dimensional quality such that you can say that Doctor A has more competence and caring than Doctor B unless the many, many differences in delivering patient care you're going to run into all happen to come down in Doctor A's favor. In other words, rejecting your claim that gender of the provider can be categorically said to have nothing to do with competence and caring does not imply a claim that women can generally be found above men on the competence and caring scale.

If I misunderstood you, and 'competency and caring' is something more specific, that doesn't address all aspects of delivering patient care, I apologize for the misunderstanding.

And I was responding to this comment: This is another reason that there should be no such thing as a male OB/GYN*.

And I strongly disagreed with that comment as well, way back in 45.

425: so your response is, "I'm not going to talk about this anymore"? Okay.

the fact that I have half-baked surmises doesn't require me to lay them out and defend them as if they were beliefs I was committed to.

It sort of does when you accuse someone of "playing dumb" for disagreeing with the premise of your half-baked surmises.

the surest way to get someone to refuse to admit any given point is to aggressively persist in badgering them to admit a given point.

While I have not yet mastered the technique, I was taught as a young lawyer that one of the best ways to get someone to admit something in a deposition is to make them think that you are trying to get them to admit the opposite.

426: As I said to Brock, I'm not arguing about the difference between 'preferable' and 'better', if that were the sticking point, it would be silly, wouldn't it. All I've been saying throughout is that I would be very surprised if there weren't gender socialized differences that impact on patient care.

He has been calling you on precisely what you are saying -- that you believe women are "better" or "preferable" on a very specific dimension.

I offered one specific example in which I believe there's likely to be a difference where female OBGYNs are likely to be preferable -- sensitivity around weight gain issues. If anyone wants to argue that I'm wrong about that specific example, I'm all ears -- I'm not strongly committed to its accuracy. Will has, not, in fact, been 'calling me' on that specific issue, or if he has, I have missed the comment in which he did.

That one example does not imply that I believe that all average gendered differences between male and female doctors are in favor of female doctors. In fact, I've specifically repudiated that position several times above.

I can't help but notice that (in comment threads, litigation, etc.) that the surest way to get someone to refuse to admit any given point is to aggressively persist in badgering them to admit a given point.

I couldn't agree more. See my 396.

"Competency and caring having nothing to do with gender."

And I was responding to this comment: This is another reason that there should be no such thing as a male OB/GYN*.

This is why we get the big bucks people! It is amazing how two pig-headed lawyers can spend so much time on two simple statements. (LB and me, not the others)

429: Huh. Is the issue here that Will's pissed off about my 56? Because that was an extremely snippy way of me to put it, and if that was the point of offense, I do apologize.

But of course 56 wasn't addressed at disagreement, it was addressed at what I understood to be a claimed failure to understand what connection gender could possibly have with patient care. Disagreement would have been easy to engage with, but I was having a tense, cranky day, and didn't want to have to go into "Well, Will, in our society, men and women are often socialized differently. And those differences in socialization can affect their communication styles, and in a communication-heavy process like the provision of medical care, it seems likely to me that gendered patterns of socialization are going to affect the provision of patient care." I was being lazy, and wanted to prod Will into acknowledging that he could see a possible connection between gender and patient care.

But nonetheless, that doesn't excuse my rudeness. Will, if you found 56 offensive, I do apologize.

While I have not yet mastered the technique, I was taught as a young lawyer that one of the best ways to get someone to admit something in a deposition is to make them think that you are trying to get them to admit the opposite.

I've seen it done in a transcript -- a medical expert, in fact, if memory serves. It's always so fun to experience these moments on paper, seeing exactly where they are going, knowing that the witness is so caught up in the moment that s/he doesn't see it coming, and finally getting to the gotcha line of testimony. It's so beautiful.

428: No, my position is that I'm not going to lay out positions that I'm not committed to as if I was. If you want to argue with me about a position that I've actually taken, I'll talk about it all day -- I've shown a dog-with-a-bone-like incapacity to drop anything, haven't I?

So women are snowflakes and men are dogshit. Got it.

I was being lazy, and wanted to prod Will into acknowledging that he could see a possible connection between gender and patient care.

I certainly can. Just as I can see a connection between gender and the services that lawyers provide their clients.

Honest, Brock, it's not women generally. Just me. And not men generally either. Just you.

A doctor (arrogant young-ish male) once asked me if I had ever thought of doing anything about "The Weight". I was probably only about 20 lbs over and I'm very tall (5'10") and large-boned (wear a 12-14). I laugh now, but Jesus Christ!

A guy I dated (with whom I had never been more free of body-related insecurities) told me that I was really insecure because I was overweight (again...I shop at the "normal people" stores) and "my problem was that I was really tall, so I'd always look big". What a gem, I miss him!

430: Idealist started at the firm of Mounds, Wilson, Krumphorn, Bre'r Rabbit and Newbury.

437: Sure thing, me too. I've got negotiation techniques that I see people using that I can't, because of gender, and I've got techniques that work for me that most men probably couldn't pull off for the same reason.

I've got negotiation techniques that I see people using that I can't, because of gender, and I've got techniques that work for me that most men probably couldn't pull off for the same reason.

You're not talking about a low-cut blouse, are you?

439: What a gem, I miss him!

But the vegetables came in really well the following summer.

Doesn't every doctor ask every patient about their weight? I'm not sure that I have ever been to the doctor where he or she hasn't weighed me and raised an eyebrow.

And, despite what the pictures show or what W-lfs-n says, I am not really that fat. Just stocky.

My husband is a powerfully built but chubby man, well into "overweight" on the charts, and no doctor's ever said a thing.

I find this comment hard to believe, Cala. I suspect that your hubby simply doesn't remember the doctor saying something to him about his weight.

437, 441: Maybe this is why I gravitate toward appeals -- I can see nothing about my practice that gender really impacts all that much. Yes, sure, it can affect whether the old boy trial lawyer will trust you judgment with his case, but the actual practice of briefing and oral argument may very well be the most gender neutral area of the law. Huh. I can totally see it in trial work, which is probably why I mostly suck at that level.

Doesn't every doctor ask every patient about their weight?

Mine always have.

442: Nah, I don't have the rack for it.

No, I mean I think I have an easier time calming a situation where an opponent is being hostile and blustery than most men would -- not particularly because I'm calmer myself, but because backing away from a fight looks weaker when a man does it than when a woman does. I can pull a "Come on, we're not actually personally fighting here, let's get back to business" that doesn't make me look conflict-averse in a weak way.

On the other hand, I can't really bluster well myself. I can be aggressive, but I have to keep it cool -- shouting at people doesn't get me anywhere, while I've seen it work fairly well for men.

knowing that the witness is so caught up in the moment that s/he doesn't see it coming

Another of the best pieces of deposition advice I ever received was in response to my asking the partner to whom I was assigned if she had made a deposition witness cry. She responded that such macho stuff was stupid, and that if you were good enough, the witness and lawyer would take weeks to recognize how badly they had been hurt by the deposition. She was, of course, exactly right.

She responded that such macho stuff was stupid, and that if you were good enough, the witness and lawyer would take weeks to recognize how badly they had been hurt by the deposition.

From the other side of the table, I tell witnesses being deposed that it's supposed to be a grindingly unpleasant process. "If you're feeling comfortable, and you think you're looking intelligent and making some good points, something's going terribly wrong. Stop talking immediately."

"If you're feeling comfortable, and you think you're looking intelligent and making some good points, something's going terribly wrong. Stop talking immediately."

So if you think that you are totally blowing our case, keep talking!

I've seen an employee-witness in an internal investigation reduced to tears. I wasn't the one doing the questioning at the time.

Whether it involved macho stupidity on our part or not, tough to say. The lawyer doing the question is certainly macho. On the other hand, the deterrent effect of those witness interviews was arguably an important part of our job.

Doesn't every doctor ask every patient about their weight?

No!

@444 and 447
Of course they ask about their weight when it is a concern, but it's the tone "THE WEIGHT" as if he verbally airquoted it--finally mentioned the white elephant in the room. There have long been sensitivity issues related to the discussion of weight loss and it could be handled better. The way he was talking made it seem like it was gastro-bypass time, not really appropriate for someone wearing a size 12.

if you were good enough, the witness and lawyer would take weeks to recognize how badly they had been hurt by the deposition.

What's funny is when even the guy taking the dep has no idea he struck gold with a witness. I just wrote a summary judgment quoting a huge admission by our opponent's expert, and the trial lawyer's jaw dropped, "He really said that?" The trial lawyer who took the dep, that is.

445,454: He could be forgetting, but I suspect his doctor didn't really think to mention it, because he seems to be otherwise healthy.

When I started working at the medical school

JE, were you at OHSU? We probably have a mutual acquaintance.

Yes, mostly in pathology. I was low-level and only knew people haphazardly, tough.

Je/rris He/dg/es is the person I'm thinking of. PNW boy (actually grew up one podunk town over from where I started out), now dean of the medical school here.

455: That is funny. I can see not knowing what was said until you get your hands on the transcript -- I've heard things that sounded great but then dissolved into nothing on paper, and excellent admissions that just went by during the deposition, but leap off the page at you, but the guy didn't even read his transcript? Lame.

No, I might have run into him but I don't remember. I actually worked mostly on the hospital side but knew a lot of people on the medical school side. There about 5000 people working there.

460: I'm kind of thinking that the witness didn't really mean what he said, and that everyone who was physically present knew from body language or something what he really meant. But, hey, the transcript does not lie!

I (unintentionally) made a witness cry in a deposition, once. Not by badgering or being a jerk, but by quietly and methodically putting facts and documents in front of the witness that made the witness cry. In the unique circumstances of that depo and case, it was a huge positive to have video of this particular witness teary-eyed. However, in an ordinary case it is one of the worst conceivable strategies to provoke a witness to tears, because the jury is of course becomes immediately more sympathetic with the crying witness than the asshole lawyer.

The converse: I recently had a witness in depo threaten to punch me once, and shout "You're an asshole! How fucking stupid are you! You are a fucking dick!" Now eliciting that testimony was worth its weight in gold.

461: ER doc and administrator, and I think there for a long time, but yeah, big place.

Oh, I can see that -- if you were there, and know what it sounded like, you don't see it on the page with a fresh mind. Idealist, actually, had advice for witnesses that's partially addressed to that issue: listen to the question, formulate your answer, and visualize it written out on a blackboard. This slows things down, keeps the witness from getting too comfortable, keeps the answers short, and hopefully alerts the witness to answers that are going to look bad on paper.

(Hey, I've got another gendered issue in lawyering. The classic technique for reining in an over-exuberant witness is to call for a bathroom break, and speak sharply to them in the privacy of the bathroom. Of course, with a non-gender matched lawyer/witness pair, there are problems with this.)

The converse: I recently had a witness in depo threaten to punch me once, and shout "You're an asshole! How fucking stupid are you! You are a fucking dick!" Now eliciting that testimony was worth its weight in gold.

I think I have mentioned this incident previously.

An unrepresented husband was given the chance to ask questions of his wife. He started out strong, "Isnt it true that you are a slut and a whore?"

The wife's father didnt take the question very well. Ultimately, my partner's shirt sleeve was ripped in the process.

He started out strong, "Isnt it true that you are a slut and a whore?"

"Objection. Compound question."

466: Yet another reason I do not litigate. The worst vitriol in an appeal is maybe your opponent writing in his brief that your argument is "tortured" or "misses the point." (I'll have you know, I did *not* miss the point! And my argument totally consented to the whole thing.)

You know, there should be some sort of Mineshaft sponsored CLE -- lots of great tips!

The classic technique for reining in an over-exuberant witness is to call for a bathroom break, and speak sharply to them in the privacy of the bathroom.

Is it not acceptable practice to just ask for a break with no reason given but for the clear purpose of taking your client out in the hall and chewing them out? AFAIK that's the usual approach around here and perfectly OK as long as you don't try it when there's a question pending.

re: the bathroom break problem.

I have faced this as well (women can be witnesses too, although I agree that it is more likely to come up for female lawyers if they are commercial litigators). I just ask for an empty office or conference room, which is actually better, because when I use the bathroom break technique, I feel a bit silly checking to make sure all the stalls are empty. Even better (except for the witness's health) are witnesses who smoke. In NYC that means a trip to the street and out of opposing counsel's office.

Not-Hamlet, I left in 2002. I knew the deans until slightly before then but not the one who came in.

I'm loving the lawyer shop talk. In fact I love eavesdropping on professional shop talk pretty much regardless of the subject.

taking your client out in the hall and chewing them out

Sometimes awkward in opposing counsel's office.

Plus, it would be unusual in NYC to use wanting to speak to your witness as a reason for a break unless it was to conference on a question of privilege (although I have seen it done). Indeed, in the Eastern District of New York, "An attorney for a deponent shall not initiate a private conference with the deponent during the actual taking of a deposition, except for the purpose of determining whether a privilege should be asserted."

If I ever get serious about the idea of relocating to PDX I may have to learn more about that place. It doesn't appear to be as easy a place to find public-sector work of my sort as Seattle is, but I really don't think I want to live in Seattle again.

I'm thinking of a more organized iron cage match arguing tournament between all the lawyers here.

476: Yes! Fun! My specialty is waiting on the sidelines until things have cooled down and then mercilessly nitpicking the people who had to think on their feet. So I'll do that part.

And that differs from Unfogged how?

Uh, 478 -> 476 ... originally

474: Yeah, that's my experience here too. Taking your witness to the woodshed is a vaguely shady thing to do, although everyone does it, and so you do it in a cagy manner.

Unfortunately I don't get the $50m.

474, 480: I don't do much in the way of depositions, but in my limited experience it's appeared to me that defending counsel often have something of a prearranged "objection code", which the witness understands to mean "shut the fuck up already", thus mitigating the need for a private woodshedding.

prearranged "objection code"

My attorney tells the tale of a client of his that he knew to be a chatterbox. He had instructed the client to speak in simple, direct answers to the question with no elaboration. They had a prearranged signal should the client start to stray.

No surprise when the client beyond what was necessary and trigged the signal from his attorney. But the client then adjusted his seat so that he would not be looking at his attorney, and spoke directly to the judge.

I believe they did not prevail.

482, if there really is a pre-arranged code, is straight coaching and is totally unacceptable, not to mention illegal. That said, bad lawyers try this all the time, but it has its risks. I once made a total fool of a witness who simply repeated his lawyers' objections as deposition answers. The case settled soon after that.

The "listen to the question and answer only the question" instruction, which is fine to make on the record, is totally legitimate, though, and very useful.

He had instructed the client to speak in simple, direct answers to the question with no elaboration

It is astonishing how hard it is to get people to do this. When I prepare deposition witnesses, I routinely spend an hour or two explaining to them that all they have to do is give short truthful answers to questions they understand (and explaining the process they should follow to do so). And sometimes they still do not get it. Some people cannot resist trying it their way, and trying to be clever, even though it very often turns out very badly.

Idealist --

Try videotaping them during prep, and then playing back their answers to them with them in the room. That's worked wonders for us.

videotaping them during prep, and then playing back their answers to them with them in the room

This sounds like a good idea, at least for witnesses with enough of a sense of shame to see how poorly their attempts at cleverness play.

Seriously, it's awesome. Even the most arrogant dude is usually humbled by seeing how foolish they look on film. Totally worth it.

if there really is a pre-arranged code, is straight coaching and is totally unacceptable, not to mention illegal.

Oh, no question, but really not a whole lot you can do other than tell defending counsel to can it and argue whether the objections are going beyond proper bounds.

And maybe "code" is overstating it, more a sense that the witness has been told to slow down and quiet down when the objections get wordier, louder, and more obnoxious. Only in one instance that I can think of was there anything more specific and utterly outrageous, and we were tempted to call it quits and go to the judge, but decided for various reasons not to.

How many fucking lawyers are there on this blog?

I like the videotape idea. Indeed, the best job in the law is being brought in for depo prep of someone else's client: you get them to give away the case with six leading questions. (It's really good with your own clients too -- they're taken aback by the sudden change in tone, and definitely taken down a peg by good cross examination that goes straight to the weaknesses of the case).

The second best job in the law is preparing a colleague for appellate argument by playing a judge. You torture them with unanswerable hypotheticals, bad puns, bad faith misunderstandings, the whole bit.

490: Enough for a "Sweet Sixteen" three round iron cage match no-holds-barred litigator tournament!

Ultimate Law -- with none of the sissy rules that courts have.

490: Everybody on this blog is a lawyer (or a computer programmer or works in finance). Things have gone to hell since ogged left.

When I prepare deposition witnesses... do you deal with 87YO people who can't remember what happened yesterday, much less what happened 18 months ago? My mother's up-coming depo is gonna be "interesting".

Who is allowed to be present at a deposition? If she doesn't want anyone except her lawyer and the other side's lawyer in her home can she make that stick?

I am totally with togolosh on the topic of shop talk. This is great!

Ultimate Law -- with none of the sissy rules that courts have.

Not a bad description of a deposition, actually.

Who is allowed to be present at a deposition?

As I understand it, the general rule (at least in federal court, it may vary in different states) is that depositions are public proceedings, and in theory anyone can walk in to watch them the same way they can a trial in a courtroom. Beyond some specific exceptions (having to do with sequestration of witnesses), you'd have to convince the judge of a need to close the proceedings, just as you would if you wanted to close the courtroom for testimony at trial.

490: Don't be silly, Brock - if the lawyers were all out there fucking, we wouldn't be posting, would we? [Tho', I confess, I no longer describe myself as a "lawyer", what with having abandoned the profession some years back and going into honest more creative work.

498: Whoa, DE too? Apparently even the people who aren't lawyers now once were lawyers.

Well, I can say that I am not now, nor have I ever been, a lawyer.

497 -- No, it's a property law question. No one can be in a conference room at my office without consent of my firm.

So, 494, other than the lawyers and the court reporter, she doesn't have to let anyone into her home.

496 -- I try to bore witnesses into concessions.

OK, all you with 4 year olds [or recently with them] - what do they like for toys? I've got $50-$75 bucks to spend on a 4 year old boy who wants "learning toys". Or his mother wants. This is a take-an-envelope-off-a-tree-and-buy-stuff-for-poor-kids-for-Xmas thing and I don't remember what my kid played with at that age beyond Hungry Hungry Hippos and something with stones that vaguely resembled backgammon. Oh, and a variety of Sesame Street & Learning Co. computer games, which are not an option. [I will be including some stuffed animals and books, as well as the "learning" stuff.]

499: Eighteen years of Estates & Trusts and non-profit corporations. I so don't miss it.

501: Eighteen years of Estates & Trusts and non-profit corporations.

Is being a lawyer just a phase some kids going through, like dressing goth or being a vegan?

I always hated walking past the crowd of lawyers outside the school doors because of the cloud of smoke from clove cigarettes.

something with stones that vaguely resembled backgammon

This. I'm not remembering what it's called. An african game, I seem to think.

Mancala?

Holy Shit--Hungry Hungry Hippos! Do they still sell that? If so, you should definitely buy it for this kid. I know I'm going to buy it for mine.

From 498 we can conclude that DE has become a tax accountant.

Once Were Lawyers
A great movie. Love the facial tattoos. But so violent.

287: I get this from my shrink, but he knows me a lot better than my PCP. I have a sneaking suspicion that when he talked to her about a problem that came up in my sleep study, he told her that I like to have more information rather than less.

She's pretty good when I ask her about pubmed studies, although often it seems to boild down to (as in my question about brands and types of birth control) well some research says this and this is teh theory, and some research says this and this is the theory, but really every one's body is pretty idiosyncratic, and you just have to try one and see.

310: I gained about 10 pounds shortly after going on the pill, and I was kind of worried, but my doctor didn't care, because she said I was still well within the normal BMI range. Since she has never berated me for my weight, I haven't felt any need to get into an argument with her about the value of the BMI as a measure of health.

497 & 500: Thanks. The need to close the proceedings is the threat that she will rise from her hospital bed and smite people hip and thigh with the jawbone of any ass who annoys her.

She simply no longer cares who she insults when she gets angry and she's got a fine command of gutter language (usually kept well-hidden).

500: yeah, I was quite wrong about depos being public like trial testimony, they're not.

But issues can arise when a party wants others there (don't know if that's Biohazard's situation). The one time this arose for me, the other party refused to go forward if we closed the door on someone we didn't want in the room. This was years ago and I don't recall the details, but we concluded we'd need a 25(c) protective order, and that we didn't really have grounds for one, so we relented.

Mancala?

Yes! Thanks. I've no idea whether it's too much for 4-year-olds, but I'm thinking the tactile nature of the pieces would be quite attractive and good to them. Maybe 4 year olds are more in checkers territory? (You can see I'm clueless about little ones; the last one I spent time with was into sliding around on the floor and peeking her fingers up over the edge of the table like a periscope. She has a piratic nature.)

So, these games aren't solo learning situations, in any case, so if mom doesn't have the time or inclination to be involved, the child might need or want something different. Are we talking legos here?

I apologize to Biohazard and those who are discussing his situation; I hadn't followed. Apologies for being tangential.

Legos strikes me as a perfect no-fail educational gift. The mom may have some other idea of what educational means, but she'll probably be happy.

So, do you want your mom to win her case, or do you want her to be legendary?

508: [Hungry Hungry Hippos] I know I'm going to buy it for mine.

Lest he become Donnie Darko.

My parents didn't get me what I wanted for Christmas.
What did you want?
Hungry Hungry Hippos.
And how did you feel, being denied these hungry, hungry hippos?
Regret.

Parsimon, no problem. This case is tangential too. I think it will be okay then. She doesn't want some family members in addition to their lawyer from the other side in her place and it looks like she doesn't have to let them in.

John, if she had a gun she'd already be legendary and not in a good way. This has gotten well into the vendetta stage.

Legos strikes me as a perfect no-fail educational gift.

Agreed. You really can't go wrong with Lego (and I say this as someone who of course steadfastly opposes Denmark's bogus territorial claims to Hans Island).

Is it educational? Yeah, probably. But if so, it's educational in the best sense (by which I mean, oh, something vaguely opposite to 'educational' in the annoying sense of explicitly and joylessly didactic).

The only problem with Lego is that the smaller pieces tend to migrate to that hard-to-reach spot just between the couch frame and the couch cushions, and there they squat, for months at a time, maybe, depending on how often you dare to look behind your couch cushions.

The only problem with Lego

So, but 4-year-olds are okay about the whole trying to swallow (and choke on) little pieces, then? Of course there are large sized legos. Lego.

I guess they don't make Lincoln Logs any more. Those were cool. Maybe I played with those when I was only 3, though, instead of 4.

http://lincolnlogs.knex.com

They live!

I dunno; what does one build with Lincoln Logs other than the same damn cabin over and over? I much preferred the versatility of Legos, or really, Construx, which I now learn were only made from 1983-1988 (modulo a brief period in 1997).

They do make Lincoln logs, but I think 4 is a little young for lincoln logs, as they take more skill to actually build with than Legos. Knockoff jumbo Legos branded as mega blocks (blox?) are good. Maybe magnetic letters for the side of the stove or fridge for a bonus, not the cheapies with poorly attached magnets. Oh, and a big set of plain wooden blocks in assorted shapes is also really good, toy stores and department stores carry them now.

Not a lawyer.

490: Everybody on this blog is a lawyer (or a computer programmer or works in finance). Things have gone to hell since ogged left.

The blog really hasn't been the same since all the academics were chased off . . .

Biohazard beat me to it. Yeah, they still make Lincoln Logs. They're not easy to find, though. Well, easy enough to find on the internet, I guess, but not exactly a loss leader (you know, real wood) at your nearest local IRL toy store.

So, but 4-year-olds are okay about the whole trying to swallow (and choke on) little pieces, then?

No worries about 4-year olds, Parsi. 2-year olds are a different story, of course: there is just about nothing in the known universe that cannot be defined as a potential choking hazard for a curious 2-year old. But Lego comes in all shape and sizes; and it's all classified, all Scandinavian-like, into rationally-based and tastefully-rendered age-appropriate categories, which system of classification has the added benefit of teaching (without seeming to teach, so: educational in the best sense) the youngsters the basics of good design.

Yes 4 is right about the transition from Duplos to Legos themselves. But they interoperate well, you might consider a mix. I found the mix was fun to have.

The only problem with Lego is that the smaller pieces tend to migrate to that hard-to-reach spot just between the couch frame and the couch cushions, and there they squat, for months at a time, maybe, depending on how often you dare to look behind your couch cushions.

Also, sometimes the pieces stick together really, really tightly. Though I hear they have a tool now for prying the blocks apart.

There's another kind of building toy that is plastic bricks of various sizes. I don't remember the name, but the surfaces are such that you can stick the blocks together; they're covered in thick plastic thistles about a quarter inch tall, so they smush together.

Legos are also enlargeable, so if the kid likes the basic set you can get the jumbo deluxe set, until finally he's sleeping in his own lego hut in his bedroom.

Iceland, Denmark, and Russia are going to forcibly recruit Canada, Norway, Finland, and Sweden into their Arctic Coalition.

I'm psyched that Lincoln Logs live. And they're harder than Legos?

Maybe it's true that I just made variations on cabins and tall stacks of crossed wood with the lincoln logs -- boring. It's been a long time, but it seems to me I had to think about how to make the door or window work out properly. So yes. I'm not sure why Legos weren't as interesting. It's possible I just liked the wood, and didn't like the snapping into place of the Legos, an aesthetic thing.

And according to lw, we're still being too advanced here for a 4-year-old?

At age four boredom is an alien concept.

532: I can tell you from the close proximity with 4 year olds that this is a highly false statement.

Boredom is a social construct at any age.

I'M BORED WITH THIS THREAD!

Boredom is a social construct at any age.

I'm speechless.

Also, if Walt hangs out with 4-year-olds so much, he should say what educational toys they would like.

I second lw's vote for wooden blocks of varying sizes. Those are great and stay interesting as the kid gets older!

I would build structure after structure, using wooden blocks of various sizes as walls, and volumes of the Gardening Encyclopedia as the floors of my buildings.

Iceland, Denmark, and Russia are going to forcibly recruit Canada, Norway, Finland, and Sweden into their Arctic Coalition.

Never!

To thee belongs the rural reign;
Thy cities-- shall with commerce shine

Yes, and even our uninhabited, and uninhabitable, arctic islands somewhere up in God's knows what ungodly northern latitude, that nobody in Canada would even care about except that somebody else wants to make a claim, shall with commerce shine, or so says Stephen Harper...

Okay, if this ever comes to a real pass, we're pretty much fucked, basically. I doubt we could even win a hockey match against the Danes, frankly. Our players are now mostly goons who provide good footage for "best hockey fights ever" youtube clips, whereas the Scandinavians still believe in skill, and even elegance, in the rink.

The full set of the Gardening Encyclopedia for Nid's next birthday!

The 4-year olds I know pretty much just like TV.

Good gifts for a 4-year old: art supplies, hand puppets, capes with their initial on them. There's a butterfly habitat you can get where they can raise caterpillars into butterflies. uncommongoods.com has some unusual kids stuff. When I was 4 I received my education on the mean streets of Philadelphia, so you could try that.

When I was 4 I received my education on the mean streets of Philadelphia, so you could try that.

Oh, that sounds good, and possibly educational. But given the current state of the economy, I only shop at a discount, of course. Can anyone tell me where I can get 'mean streets of Philadelphia' at wholesale?

art supplies, hand puppets, capes with their initial on them. There's a butterfly habitat you can get where they can raise caterpillars into butterflies

Hippie.

531: Me too! I loved my LLs. Add some Cowboys and Noble Indigenous Inhabitants in conflict, or some Panzers vs Shermans and hours flew by.

Anyway, Legos are good too but they cause severe pain when stepped on in the middle of the night with bare feet on a hard floor. Get really deep pile carpeting installed before buying Legos.

544.1: You were such a boy, Biohazard. I think I just used rubber-band generated catapults on mine.

542: You can now make the mean streets of Philadelphia at home! Just punch your children while chain smoking and drinking a beer.

Anyway, I do think that lipo advertisements in an OB/GYN office are extremely strange

Maybe that's where Jamie Spears got the idea. Anyway, it turns out that if you're underage and pregnant, you're still a candidate for liposuction. Learn something new every day!

Just punch your children while chain smoking and drinking a beer.

Easy-peasy! And no sooner said than done...

Man, lately this blog is all about existential angst at a discount. It's like the long, dark, Walmart-sponsored night of the soul.

I haven't noticed the existential part. Or is that just about aging?

Ask the mineshaft, night horrors edition!

WTF is black, gooey, pinky-sized, stings you, and MOVES????

The heart of an ungrateful baby?

550: Dennis Quaid, in some ill-thought sequel to Innerspace, wherein he pilots a soft-shell stealth vehicle?

Seriously, Michael? Uh, it's moved fast enough that you can't capture it?

Are you underwater? Sounds like a leech.

Anything that's pinky-sized but moves too fast to be captured is an abomination frightening.

Oh, wait, I know this one: a herring.

I could've captured it if I'd wanted to hang on to it after I wiped it off my arm. But instead I wanted to go wash my arm off. Whatever it was, it was gone when I came back and can't be found.

I was thinking some kind of black slug, but i'm not sure how it woud have hidden. I am vexed. Vexed and confounded.

Wrongshore's answer in 556 was really better, Michael.

But look, you don't sleep on a mattress on the floor, do you? In which case, OK! You're alright for the night.

Next time capture it.

Common stinging caterpillars

The only way one of them could move quickly away is if a bird flew by and ate it, though.

I know green, singing herrings that hang out on walls, sir, and what crawled on me as I reclined in my favorite comfy chair was no green, singing herring prone to hanging out on walls.

More stinging caterpillars - including non-dangerous ones

if a bird flew by and ate it

It's rather old-school and probably sexist to refer to Michael's late-night laydeez as "birds". Let alone the business about them eating worms. Seriously.

Slugs don't move very quickly either.

ok, that Hag moth, aka "monkey slug", from Ned's second link truly is a terror. I now feel better about whatever was crawling on me, because at least it wasn't that.

"Along the body there are nine pairs of fleshy lateral processes which bear hidden urticating setae."

The only way to respond to a statement like that is with a hearty "So's your old man."

I'm gonna go back in the dark room and see if I can surprise it with a flaslight.

It's clear that what you describe as its 'moving' was actually your wildly flinging it off your arm as you leaped up from your chair, and the poor thing is probably lying stunned, senseless, against the baseboard somewhere.

Don't defend mollusky creatures you don't know.

In related news, I give up. It'll have to stay a mystery.

Funny, I was going to say that about the flashlight. When in doubt, hunt.

The thought of surprising a slug is hilarious.

Beware, if the caterpillar thinks it's cornered, it will lash out with its great hooves.

569: Right, well, still, I'd clear out the rotting leaves and such from the house as a preventive measure.

(More seriously, I'm amused by this because I remember well a horrid incident of some freaking gigantic 4-inch-long beetle type of thing in the bed once years ago. Moved fast and had us up and screaming in 2 seconds flat. And we tore the room apart before we were done. Thing not found. And the mattress was on the floor.)

I'm gonna go back in the dark room and see if I can surprise it with a flaeshlight.

Have you considered that it might be the tentacle of a far larger creature?

re: night horrors

A bat once flew into our living room when I was watching TV. Surprisingly huge when up close and fluttering at your face.

I chased it upstairs and slammed it inside the spare bedroom. Then, teh horror*, watched as it crawled towards me under the door [which shouldn't even have been possible given the gap under the door was only 0.3" or so]. Finally it flew into another room and disappeared and I never found it again.

* I have no bat phobia, but black furry rodents crawling under your door [wingéd or not] are creepy ...

Rabid bats can bite you while you sleep and not leave a mark. And you never know if you got rabies and you die. I heard it on This American Life.

Rabies isn't really a problem in the UK, thankfully.

I have no idea what species of bat it was -- the UK has a dozen or more -- although it was blacker looking than yer standard pipistrelle and had a fairly large wingspan. The house I lived in at the time was in the grounds of a Georgian 'manor' and was a paradise for wildlife.

Shortly after moving to Alabama I found a scorpion in the bathroom of the apartment. For a moment I was frozen in indecision and then it moved towards me. I turned it into a monomolecular film and then spent a hour looking for his or her relatives.

Later, thoughts of scorpions, brown recluse spiders and poisonous snakes meant the air conditioner filter in the nasty crawlspace under the house didn't get changed very often.

346: Why do medical journals refuse to talk about the problem of childhood obesity? They all use "overweight" as a noun.

357: I know a neurosurgeone who is sometimes described badly by his colleagues, but his patients seem to like him who got a Ph.D. in philosophy. This was after he'd already trained as a doctor. (Undergrad here, med school in Canada, training here).

502: 499: Eighteen years of Estates & Trusts and non-profit corporations. I so don't miss it.

Was it that awful, DominEditrix? That always seemed like an area of the law where one could be useful. I mean, estates and trusts are often about helping rich people, but I could see myself setting up trusts for disabled kids and feel like I was doing a useful service.

Non-profit corporation law is bad too?

Nine tenths of the law relating to charities is tax ...

And come to think of it, bg, we'd talked about tax and it seemed like a good fit for you. Making T&E not a big jump at all.

Rabid bats can bite you while you sleep and not leave a mark. And you never know if you got rabies and you die. I heard it on This American Life.

My mother called me to inform me of this. Thanks, mama, for that supremely useful and time-sensitive tidbit!

Bats can give you rabies without even touching you, by peeing on you while they're in flight.

You can get plague from a cornea transplant, if the donor died of plague. Always ask.

579
Sensitivity, if that isn't too obvious. Without knowing the history precisely, it was generally found that calling someone's child obese offended so many parents that it was counterproductive. Cultural norms that affect adults to a certain level affect their perception of their children to a much greater extent, and it is almost impossible to have a rational discussion with a parent when they are challenged about their child's weight. I think the main reason it is so pervasive is the growth charts that are often distributed to parents. If you can't write 'obese' on the chart, then you would either have to maintain 2 separate terms, one for the docs and one for the parents, or simply accept the overly PC 'overweight.'

The boyfriend worked on a project about overweight in children (that isn't a typo, but the generally accepted way of writing it in the relevant literature), so I ended up reading about it more than I would have liked.

My mother had a badminton recket next to her bet to drive off bats. One time when my grown sisters were visiting a bat flew into the room and they woke up my mother by screaming. She came in to see what the problem was and saw them hiding under the table. "Yes, we have bats," she said. "Go to bed". It's really bad form for a house guest to scream at the host's bats.

In Taiwan I woke up once to see a mud-dauber wasp delivering a caterpillar to the mud nest it had built on the wall. I also had wasps hatch in my Portland apartment a couple of times. I guess wasps just like me. Very flattering, no?

It's not so hard to be liked by wasps. Just keep your tennis whites pressed, maintain the brightwork on the yacht properly, and don't bruise the gin.

And don't make a fuss when they feed caterpillars to their young.

But how do I get the stinging rose caterpillar to like me?

And above all don't be obese overweight of a robust and hearty weight.

Portly, after a certain age, is sometimes acceptable.

Caterpillars are comprised primarily of protein, and have no trans fats, so they never lead to childhood overweight in wasps. That's why their waists are so lovely.

Bats are unbelievably soft. I've helped remove bats from people's houses, and every time I'm amazed at how soft their fur is.

Watching bats catch bugs in flight is awesome. Such precision and speed. Makes you proud to be a mammal.

re: 593

They used to roost somewhere near the house I grew up in, and you'd see huge flocks of them over the fields/park in the early evening sometimes. I had no idea where they roosted, though, as there didn't seem anywhere close by that would suit.

A friend ate a big roasted caterpillar in Africa. Tastes like shrimp. High cholesterol.

592.last made me smile.

Re: bats, I've been swimming at twilight when a cloud of them swoop through. Just beautiful, and oddly adorable with the soft squeaking.

Bats in the house, much less appealing. I had a colleague who woke up to one in her bedroom when she was a nursing mom with a toddler. They had to get rabies shots. Ugh, ugh, ugh.

The second best job in the law is preparing a colleague for appellate argument by playing a judge. You torture them with unanswerable hypotheticals, bad puns, bad faith misunderstandings, the whole bit.

CharleyCarp for the win! Who would have believed that a lawyer's job could actually be fun?

Bats only come out at night and nest in hiding places. They're much much more common than people think. Considering that, the number of rabies cases is very few.

596: Swimming with bats is awesome! Especially when they swoop down and take a quick sip of water while on the wing. Just lovely creatures.

596 -- And useful too. I did this about 3 weeks ago, and some of my questions were so off-the-wall, the audience audibly groaned. Naturally, those questions were asked a couple days later by the real panel.

I have a favorite, posed to me by a Seventh Circuit panel, that I haven't had a chance to use yet in a practice session: Mr. Carp, to rule for you, we have to find that the district judge abused her discretion. Wouldn't that be mean?

Kobe^6!

599: "Yes, Judge Easterbrook, but that's not the only reason you should do it . . . ."

WTF is black, gooey, pinky-sized, stings you, and MOVES????

A succubus.

601 for the win! (I'm prepping one of our youngsters for a 7th Circuit argument in the next couple of weeks, and I am totally stealing that line.)

Kobe^6!

I believe that would be a trillion, Math Professoress.

I also had wasps hatch in my Portland apartment a couple of times

I returned to my dorm room late one night to find that a swarm of wasps had come in through the open window. It was like that scene in The Birds when Tippi Hedren goes into the attic with the flashlight, except they didn't attack; they were just hanging out doing whatever it is wasps do when they're not flying around. Still, my blood ran cold.

I believe that would be a trillion, Math Professoress.

no, it is
1000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
0000000000000000000000000000000000000000000000000000000000000000000000\
00000000000000000000000000000000000000000

Huh. I'm with Apo. 100 to the sixth power is (ten to the second power) to the sixth power, or ten to the twelfth power: 1,000,000,000,000. A trillion. What am I missing here?

What am I missing here?

The (exclaimation) point.

Bats are unbelievably soft. I've helped remove bats from people's houses, and every time I'm amazed at how soft their fur is.

I've heard the same thing about platypi, which made me incredibly jealous. Same with the worker at Palmer Station who'd helped corral some local chinstrap penguins (they're about knee-high and would be easy to pick up and carry around) on one occasion. I want a job that involves picking up cute endangered animals!

LB, if 608 was too unhelpful: if "^" gives exponentiation, "!" gives factorial

which made me incredibly jealous

PMP is unhappy because his fur is so coarse.

But is it clear it's Kobe^(6!), rather than (Kobe^6)!?

612: yes, under standard assumptions of precedence, but of course it is ambiguous.

besides, the latter would have been too long a comment.

611: I've started eating eggs to add lustre.

Watching bats catch bugs in flight is awesome. Such precision and speed. Makes you proud to be a mammal.

My new email signature. How should I credit you?

608: Gotcha. I had the exclamation point firmly filed as punctuation rather than a mathematical symbol, to the point of not seeing it at all.

LB, not a prescriptivist; she doesn't "see" punctuation.

Every sentence or sentence-like agglomeration of words and symbols is it's own special snowflake.

is it's own special snowflake.

Particularly this one.

581: Oh, there were some good things about it - when I worked at my first [low paid] office, I saw people who truly needed help, and I could volunteer down at the courthouse doing pro bono guardianship work [that's enough to make you appreciate your own life]. But I subsequently worked for some years for a boutique firm that dealt with an awful lot of spoilt nouveau riche kids who whined because Daddy had left something to charity, thereby depriving them of a few more millions on top of what they were inheriting [cocaine and chihuahuas aren't cheap, y'know].

It was, in the main, the clientele at the latter, I must admit. I enjoy the intricacies of an estate tax form [and I love audits...], there were certainly clients whom I enjoyed, but it was less about setting up trusts for disabled kids or doing much good, and more about maximising the bucks for people whose greed seemed to progress geometrically as their inheritances increased arithmetically, the sort who abuse waitresses just because they can. [I come from Olde New Englande. My father would have disowned any of his children who were so gauche as to be gratuitously rude.] And I'm allergic to expensive, civet-musk based perfumes, which often made client meetings painful.

Non-profs would have been more fun, but all I got to do was the grunt work. [Booooring form-filling-in for the IRS, tedious chats with accountants/managers. I could do it in my sleep, and sometimes did.]

I could, in theory, go back to some other field of law, but once one's let 10 years of CLE go by, it's not practical. Besides, I like baking, I have my own company and I get to make fantasies out of sugar paste. And I never ever have to wear pantyhose.

Besides, I like baking, I have my own company and I get to make fantasies out of sugar paste.

You know, while I knew you were a recovering lawyer, I'm pretty sure I didn't know you were a professional baker. So we've got two people here who followed a lawyer-->baker career path, you and M%tch. Neat.

Besides, I like baking, I have my own company and I get to make fantasies out of sugar paste.

Wow, really?! Can I send Rory to you for a summer internship? For that matter, can I come?

You know, while I knew you were a recovering lawyer, I'm pretty sure I didn't know you were a professional baker. So we've got two people here who followed a lawyer-->baker career path, you and M%tch. Neat.

I just bought the most amazing cranberry-chocolate scones from a former big firm lawyer turned professional baker.

She seemed so happy. (I do not believe that she was wearing pantyhose or high heels.)

Hah. And in recovering-big-firm-lawyer schadenfraude news, I've just heard gossip that my old firm is firing. I'm very happy to have gotten out before the stampede.

So we've got two people here who followed a lawyer-->baker career path, you and M%tch

Wait, M&tch's career is baking? I had no idea. I've heard he's been to China, though.

Help, I'm imprisoned in a Chinese sugar paste factory!

619: Particularly this one.

Hmm, didn't think you'd notice my subtle subconcious attempt at humor.

615: Plagiarize! Or credit my alter-ego, Pernicious Q. Varmint Supreme Leader of the Mammalian Nationalist Front (motto: "No Nipples, No Rights!")

comma after Supreme. Damn marsupials been fucking with my keyboard again.

Before. Fucking platypus or something I suppose.

630: I took it like a hip-hop name: Pernicious Q. and that your full title was Varmint Supreme, Leader of the....

Pernicious Q. is such a good pseud and/or DJ name.

Indeed.

I don't think it's wise to let platykittehs fuck on your keyboard. Ghod nose itz not gud to let reglar kittehs mess wiv keybraods.

633: I never do make it all the way through the band name threads.

Lawyering may have been in my briefs, but baking was in my genes...

M/tch is a baker?! Why, he's never said a word. Though I could be wrong. I have a soft spot for people with second or third careers.

636, parallel structure error, it should either be "bakering" or "lawying".

It is said that to find out whether chromosomes are male or female one pulls down their genes. Not be me, of course

Although excessively fond of baking, M!tch does not currently earn a living as a baker. Makes the best damn brownies you've ever had, though.

640: Excessively?

"Oh, M;tch, delicious baked goods again?!?!"

640: I think I actually knew that Mζtch was no longer a baker, but he did bake professionally in the past, right?

Stanley is a youth of skin and bones and does not understand the brutality of delicious baked goods.

Whoops. That was me.

It's funny because it's true.

M!tch does not currently earn a living as a baker

Bummer. Some of us don't make much of a living as booksellers either, any more. Buy more books from small independent bookdealers, dummies. Or else I'm going to have to find yet another career, which I realize concerns you much, but still.

(/end mutter)

Parsi, are your offerings online? Your books, I mean.

646. Pretend you are a bank, parsimon. I'm sure the Fed has a spare billion for you, if you ask nicely.

631 - I may adopt that approach. Varmint Supreme is an excellent Fuhrer/Duce type title. My lieutenants can be UnderVarmints.

Good luck in 2012, togolosh.

You must not be very modest to flash everybody your undervarmints.

Food topic emerges on third day to properly close out multi-hundred comment Unfogged thread involving heated discussion of gender roles.

Sunrise, sunset.

652 gets it right. Elitist food talk really is the consensus.

I was hoping this would end as the caterpillar/slug thread, but noooo.

650: Fuck. I guess I'll revert to the older form, then.

Mmmm, baked slug.

(My favorite get-rich-quick scheme is a soft-shell escargot ranch somewhere in the PNW.)

In time caterpillars and slugs will be elitist food.

soft-shell escargot ranch

Somewhow I first read this as if it were a variation on a kind of salad dressing.

"Food thread!" is the new "food fight!"

The McQ household is now deep in turkey week. Sunday: reheated turkey, essentially (I claim no responsibility). Monday: turkey risotto. Tuesday: turkey enchiladas (with mole poblano, yum). Wednesday: turkey pot pie. We've got a couple more meals worth of turkey to deal with, but fuck, I'm too sleepy to think about it.

I'm making turkey poblano this weekend for a pot luck. I did, however, freeze most of the bird and pepper the week with lasagna and chicken enchiladas, so as to keep the boredom quotient low. OTOH, the Biophysicist would eat cranberry sauce on everything, including peanut butter, if he had his druthers.

647: We do, but it's more a general point about small businesses. Everyone's heard it before. If you have the disposable income to spend the extra $2 or $3 dollars to support a small business, good on you, do that. In the book trade as elsewhere, realize that decisions in favor of the cheapest price means support for increasingly larger outfits who are not only crushing your very fine friends and neighbors, but are also controlling supply.

That out-of-print copy of what you think would be cool for a holiday present would be available from some small bookseller somewhere, but will not be available from larger suppliers with cheaply priced copies of in-print books only. As the smaller independent booksellers shut down, the range of available titles dwindles, although there are Print-on-Demand organizations now providing scanned and very cheaply printed copies of the original out-of-print texts, which they have bought from us and scanned.

I don't know what to say about this trend overall; obviously the nature of the textual experience is changing, and the book trade is on its last legs.

Uh, thanks for listening.

the Biophysicist would eat cranberry sauce on everything

I've been finishing ours up on my oatmeal all week. Good stuff.

||

For the record, I went hunting for "average weight gain" for the 5th month, and nobody quotes it at 5 pounds. Most of them say ~ 2 pounds a month, or 3-5 pounds for the first trimester and 1-2 lbs a week thereafter, or 5-12 lbs as a normal weight gain by the 1/2 way point, etc.

Dr. Jerk Butt was totally low-balling me.

|>

This is a very long thread, and everyone has already made the necessary substantive responses to Adam in 346, but I just want to say dude are you crazy, because fat babies are so fucking cute. If it were true that being overweight during pregnancy resulted in fat kids, every pregnant woman would be chugging gallons of condensed milk.

Oooh yeah. Gotta love those concave knees.

I would not be satisfied until I had a baby worthy of Maury Povich.

O RLY?

662: Maybe he finds heavy pregnant women unattractive and has a problem with treating unattractive women.