Author Archives: stfmguestblogger

Reading in Turbulent Times

Posted on July 11, 2025 | 3 comments

By Bill Cayley, MD, MDiv

“Literary experience heals the wound without undermining the privilege of the wound.” —C S Lewis (Goodreads)

In turbulent times, withdrawing to a quiet place with a good book seems more tempting than ever. Escaping to another story, another place, or another time can seem the best refuge from chaos and uncertainty. Yet escaping in reading can also feel like a guilty pleasure when it seems that something should be done. While rest and refuge are important for pacing oneself and avoiding burnout, reading can also provide inspiration as the stories of others give us insight into how they faced turbulence and chaotic change. Perhaps, as we face the current moment, a good book might be just the right thing.

Looking back over recent history, it is hard to think of a more turbulent time than the 1930s and 1940s, when the world learned that the “war to end all wars” (World War I) actually was not. In 1943, Langdon Gilkey was a teacher in China and one of about 2000 expatriates interned at the Weihsien compound for “safety and comfort” during the Japanese occupation of China in World War II. Shantung Compound (HarperCollins) is Gilkey’s story of that experience, as the interned expatriates were essentially left to themselves to organize and run life inside their compound. From dealing with hunger, jealousy, boredom, and fear (and even an exploding egg) to finding ways to make life more civilized and tolerable, the book tells a story of community and humanity in the face of isolation and deprivation. As Gilkey concludes, “Out of apparent evil, new creativity can arise if the meanings and possibilities latent within the new situation are grasped with courage and with faith.”

From World War II also comes the story of Le Chambon, a French village that was the center of a movement which sheltered nearly 5000 people (including more than 3000 Jews) between 1940 and 1944. While many find the stories of Raoul Wallenberg and Oskar Schindler inspiring, most of us are not diplomats or industrial magnates. Lest Innocent Blood Be Shed (HarperCollins) tells the gripping story of how “goodness happened” in Le Chambon as ordinary people daily risked their ordinary lives to overcome an extraordinary evil. As the author concludes his book, he reflects on the way the Chambonnais affected him during his research and writing: “I know now that I want to have a door in the depths of my being, a door that is not locked against the faces of all other human beings. I know that I want to be able to say, from those depths, ‘Naturally, come in, and come in.’”

The biographies of individuals can also motivate us and inform us with the wisdom of others who have trod paths of challenge. In Man’s Search for Meaning (Beacon Press), psychiatrist Viktor Frankl tells his own story of finding meaning in life as he faced the horrors and loss of life in a Nazi concentration camp. Coming to more recent times, the stories of those who fought for civil rights during and since the 1960s provide more than ample inspiration. While nearly all are familiar with Martin Luther King Jr, the name of John Lewis may be less familiar. The great-grandson of an enslaved man, Lewis first aspired to be a preacher, later took part in many central events of the 1960s civil rights movement, and subsequently served 17 terms in the US House of Representatives until his death in 2020. In His Truth Is Marching On (Penguin Random House), Jon Meacham tells the story of Lewis’s decades in public service, shaped by his faith-based belief that one should love one’s neighbor as oneself. Another influential leader shaped by the civil rights movement, family physician David Satcher served as US Surgeon General from 1998 to 2002. My Quest for Health Equity (Johns Hopkins University Press) is Dr Satcher’s autobiographical account of his decades-long work on equity issues through academia and public health.

Finally, at a time when the essence of family medicine seems at risk of being lost amid politics, culture wars, and threats to the integrity of science, stories of others who have walked the path of general (or family) medicine can be grounding. The breadth of medical autobiographies can be overwhelming, but a small sample of noteworthy narratives includes A Fortunate Man (AbeBooks), the story of an English country doctor in the mid–20th century; A Fortunate Woman (AbeBooks), the story of another physician (this time a woman) in the same English rural town; and What Matters in Medicine: Lessons From a Life in Primary Care (University of Michigan Press), Dr David Loxterkamp’s stories from a career in rural Maine.

How to face the current moment? Take a deep breath, take some time for reflection, and consider taking time to find inspiration and wisdom from those who have gone before.

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Using While Pregnant

Posted on June 5, 2025 | Leave a comment

A Life-Changing Knock


By Meheret Mekonnen, MS

The fear of having a newborn taken away—this is a reality for many women who test positive for substances on a urine drug screen during pregnancy. The stigma and complications of substance use disorders are associated with insufficient prenatal care, inadequate nutrition, chronic medical conditions, and domestic violence.¹

Prenatal substance use and neonatal substance exposure have become pressing public health concerns. It is estimated that more than 4.4% of pregnant women in the United States use 1 or more substances during pregnancy.² Opioid use among pregnant women and cases of neonatal abstinence syndrome have risen alarmingly, with a 131% increase in opioid-related diagnoses during delivery hospitalizations from 2010 to 2017.² Each year, approximately 800,000 of the 4.3 million neonates born in the United States are exposed to illicit substances in utero.³ These statistics, along with countless patient testimonials, highlight the critical need for health care professionals to implement screening, brief intervention, and referral to treatment as part of routine care.

One of the many challenges clinicians and institutions face is how to effectively screen pregnant patients. Many facilities still rely on unstandardized substance use screening, often in the form of urine toxicology testing. However, urine drug screens have demonstrated poor positive predictive value and reveal significant disparities in outcomes.⁴ Historically, unstandardized screening and disclosure practices have been shaped by provider bias, particularly against single women with poor psychological, financial, or social functioning; women with delivery complications; Black women; and those receiving care in public health settings.⁵

Leading organizations—including the World Health Organization (WHO), the US Preventive Services Task Force (USPSTF), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the American College of Obstetricians and Gynecologists (ACOG)—strongly recommend standardizing substance use screening as part of comprehensive obstetric care.⁶ Validated screening tools such as the 5Ps (Parents, Peers, Partner, Pregnancy, Past) offer a structured approach to assessing alcohol and substance use during pregnancy.⁷

Critics of universal verbal screening cite concerns about patient honesty, staff burden, and time constraints. Yet, successful models demonstrate that integration into existing clinic workflows, engagement of multidisciplinary stakeholders, and support from institutional leadership can facilitate adoption and acceptance.⁸

More work is needed to address disparities in substance use screening and the broader public health challenge of prenatal substance exposure. However, universal verbal screening is a meaningful step toward building patient trust, mitigating provider bias, and promoting equity in prenatal care.⁹

References

1. Wendell AD. Overview and epidemiology of substance abuse in pregnancy. Clin Obstet Gynecol. 2013;56(1):91–96. Available from: https://journals.lww.com/clinicalobgyn/FullText/2013/03000/Overview_and_Epidemiology_of_Substance_Abuse_in.15.aspx

2. Hirai AH, Ko JY, Owens PL, Stocks C, Patrick SW. Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010–2017. JAMA. 2021;325(2):146–147.

3. Joseph R, Brady E, Hudson ME, Moran MM. Perinatal substance exposure and long-term outcomes in children: a literature review. 2020.

4. Chin JM, Chen E, Wright T, Bravo RM, Nakashima E, Kiyokawa M, et al. Urine drug screening on labor and delivery. Am J Obstet Gynecol MFM. 2022;4(6):100733. doi:10.1016/j.ajogmf.2022.100733

5. Madora M, Wetzler S, Jose A, Bernstein PS. Pregnant and postpartum people with substance use disorders: understanding the obstetrical care provider’s roles and responsibilities. Matern Child Health J. 2022;26(7):1409–1414.

6. Whittaker A. Guidelines for the identification and management of substance use and substance use disorders in pregnancy. By World Health Organization. Geneva, Switzerland: WHO Press; 2014. Drug Alcohol Rev. 2015;34(3):340–341.

7. Hostage JC, Brock J, Craig W, Sepulveda D. Integrating screening, brief intervention and referral to treatment for substance abuse into prenatal care [3L]. Obstet Gynecol. 2018;131:129S–130S.

8. Chasnoff IJ, Wells AM, McGourty RF, Bailey LK. Validation of the 4P’s Plus© screen for substance use in pregnancy. J Perinatol. 2007;27(12):744–748.

9. Ulrich M, Memmo EP, Cruz A, Heinz A, Iverson RE. Implementation of a universal screening process for substance use in pregnancy. Obstet Gynecol. 2021;137(4):695–701.

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Getting Started With Your Writing: Finding Your Voice

Posted on October 25, 2024 | Leave a comment
By Sarina Schrager, MD, MS, 
Family Medicine editor-in-chief

I will often talk to groups of junior faculty, fellows, residents, and students about writing. When I say enthusiastically, that writing is fun, I am faced with a sea of skeptical faces.  Is writing fun?  Well, for most people the answer is no. Why not?  Because it is hard and for many of us no one has taught us how to do it. One of my favorite quotes about writing is by Ernest Hemingway. He said, “We are all apprentices in a craft where no one ever becomes a master.”  Well, that’s frustrating you may say. If I can’t become a master, why bother?  My answer is that seeing your work in print is worth the effort. The process of writing and editing and developing a strong final product is very satisfying. You have something to say and writing is an excellent way to share your ideas with a broader public. So, how do we get started?  

  1. Just start writing.  No one is born a great writer and the only way to get better is to practice.  Think about what you want to write and start writing. You can practice when writing for work (craft well worded e-mails for example) or in your every-day life.
  2. Try writing short academic pieces like case reports or book reviews or letters to the editor. These forms of writing are less intimidating because they are short and very structured.  Family Medicine has a new article type called Family Medicine Focus. This infographic is less than 500 words and covers a narrow, specific topic on education or professional development. (Family Medicine (stfm.org))
  3. Think about how you want to structure your work. People have different techniques for planning out a writing project.  Many people use outlines. Some people will use bulleted lists of headings or topics to cover.  Some people start writing at the end and then go back and craft the beginning of their writing. Others will start with the section that is easiest for them—just to get something down on paper.
  4. Give up perfectionism. This may sound simple, but it is hard to be a good writer if you get lost in trying to find the perfect words.  Start off by just writing. If you want to dictate and then transcribe, that can help you put your ideas down on paper. Then, you can edit, craft your argument, and look for clear ways of communicating. Pulling out the thesaurus does not come until you are a couple of revisions into the process.
  5. Ask for help. Yikes, this is a hard thing to do.  But, asking a friend, colleague or family member to read your work before sending it into a journal can get you honest feedback that will improve your writing. It may be painful, but better to address weaknesses in your writing first rather than getting rejected from a journal.
  6. Find your voice. Writing takes a lot of time and can be frustrating if you are not writing about a topic that you care about. Look around you and explore writing about your teaching, your patient care, your work experiences, or your research. You have a story to tell!
  7. Finding a time to write.  For many of us, clinical duties, teaching responsibilities, and administrative tasks take precedence and writing and scholarship quickly fall down the “to do” list. The most prolific writers have one thing in common and that is that they designate time to write. It may not be daily, or even weekly, but if you talk to someone who writes a lot, they will tell you that they block off their calendar to write. Evaluate how, where, and when you work best and take advantage of that. I often recommend a 2009 article in the Emergency Medicine literature entitled, “Tuesdays to Write”.   The author talks about designating Tuesdays for academic time and blocking off the entire day to write.  Obviously, that is not possible for many of us, but the concept is alluring. Look ahead at your calendar. Are there mornings or afternoons that you can block off to write?  
  8. Keep practicing. Maya Angelou said, “Do the best you can until you know better. Then when you know better, do better.”  Start writing for yourself and as you get better at it, share it with your colleagues and the broader family medicine community.  

Reference:

  1. Lowenstein SR. Tuesdays to write … A guide to time management in academic emergency medicine. Acad Emerg Med. 2009 Feb;16(2):165-7. doi: 10.1111/j.1553-2712.2008.00337.x. Epub 2008 Dec 30.

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