Monthly Archives: June 2010

Breastfeeding, formula-feeding, demonising, and choice

In recent months I've been following the Fearless Formula Feeder blog, a blog that… actually, I was trying to think how to summarise what it's all about in a quick phrase or two, but in fact since the main point of this post is to (hopefully) clarify the blog's philosophy I'll skip the summary.  If you're interested, do check it out, and with an open mind.  Anyway, in the past few weeks a lactivist by the name of Alan has started some debates in the comment threads which have run into a number of posts, and things have been getting pretty heated, though with an overall civility which is impressive to anyone as used to internet debate as I am.  Inevitably a lot of different and overlapping points are getting debated, and, if I get the chance, there are a few I plan to jump in on myself.  But what I want to write about in this post is this particular comment of Alan's.

In response to this comment from Brooke, a reader defending the site, Alan wrote: 

@Brooke: Thank you for your post,
because it shows clearly that despite the disavowals of some here, at
lea
st one of you (and I'm thinking quite a few more than one) *is*
pushing an agenda of prom
oting formula feeding for people struggling
with breastfeeding (the same potential "converts" the
formula companies are after). So if there are people on the fence,
not sure what to do, and you are whispering sweet nothings in their
ears about how formula's been unfairly demonised, it's not so bad,
they ought to just try it, it may be the solution to all their
problems…well, I want to be there giving another perspective.

Firstly, a few words about the issue of whether formula has been 'unfairly demonised' and is 'not so bad'.  You've indicated elsewhere in your comments that you feel this attitude has been proved wrong by the medical evidence showing breastfeeding to be better than formula feeding.  You know what?  Both those beliefs are correct.  There is indeed solid evidence that breastfeeding reduces the risk of a variety of short- and long-term illnesses and problems – but I've also seen plenty of lactivist scare stories and hype that claim benefits that aren't actually backed up by evidence and/or go way beyond what the impartial evidence supports in the way they present formula.  There is no contradiction in believing that Y is genuinely worse than X but that propaganda has exaggerated the differences between the two.

And now the main point I wanted to address: the accusation that some of the people on the site are 'pushing an agenda of promoting formula feeding'.  This was in direct response to a comment that clearly stated 'No one here is trying to make anyone formula feed, just question the
dogma that pervades certain parts of our society.'  Why was Brooke nevertheless accused of pushing an agenda of promoting formula feeding?  Because, it seems, she wants women to feel able to try formula if they feel that something is going wrong with breastfeeding.  This, as far as I can see, is what you classify as 'promoting formula feeding'.

Here (at the risk of sending this off on a massive detour into a completely unrelated and even more heated debate) is what that attitude reminds me of: the arguments about the pro-choice position on abortion rights that always crop up in the abortion debate. 

I am a pro-choicer: this means that I believe that all women should have the right and the opportunity to choose whether or not they want to continue their own pregnancies.  Back when I used to discuss such matters on debate boards, I would regularly see pro-lifers accuse pro-choicers of being 'pro-abortion' or imply/state that we were trying to push women into abortions.  And, over and over again, we would try to explain that, no, that is not what the pro-choice position is meant to be about.  It is meant to be about the belief that women should be allowed to make informed, unpressurised choices about whether or not to continue their own pregnancies.  I believe that abortion should be available for women who choose it, and that women shouldn't have barriers thrown in their way if they seek abortion.  Those potential barriers include exaggerated or incorrect information about potential risks of abortion, and a stigma of shame and guilt attached to it.  I want to get rid of those barriers, and I want a society where a woman who is unhappy with being pregnant can explore her options and can choose abortion if she genuinely feels this to be the right option for her.

And that is not at all the same thing as being 'pro-abortion' or promoting abortion.  What I'm promoting is informed choice.  My beliefs do not mean that I would ever tell a woman that she should consider abortion or try to push her towards that solution.  In fact, I would be flat-out against doing any such thing, because that would be just as anti-choice as trying to push a woman into continuing an unwanted pregnancy against her wishes.  Not only that, but I'm very much in favour of implementing the measures (better access to effective contraception, better social circumstances) that could reduce the overall need for abortion.  I would be delighted to see a drop in the number of women ending up in a position of wanting to have an abortion; I would not be delighted to see a drop in the number of women wanting an abortion and being able to get accurate information and unbiased support in helping them make the best decision for their own circumstances.  In being pro-choice, I am not promoting abortion.  I am promoting abortion rights.  Get the difference?

Hopefully you also get the analogy, but I'll spell it out to make it as clear as possible: Believing that women should get accurate and non-demonised information on formula, believing that women should have the option of being able to ask questions and consider formula as an option, believing that women with qualms about breastfeeding shouldn't be pressured into continuing if they genuinely feel that that is the wrong option for them… those beliefs are not the same as 'an agenda of promoting formula feeding'.  I believe that most or all of the people who follow this blog, including myself and, I am guessing, Brooke as well, do not believe in 'promoting formula feeding' and are in fact all in favour of women breastfeeding, just as I as a pro-choice advocate am all in favour of women continuing their pregnancies.  Now, anyone from the site who feels I'm incorrect in thus speaking for them is more than welcome to speak up now and set me straight.  But, the way I see it, we don't try to put pressure on women to try formula; we try to stop everybody else putting pressure on women to use any particular feeding method (whether that be formula or breast).  We don't try to talk women out of breastfeeding.  We just want to be sure that they feel freely able to stop it themselves if they want to do so.

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Filed under Deep Thought, Grr, argh, Milky milky, Sacred hamburger

…curtain.

One ‘Now that I’ve taken up all of the appointment time with other matters could I just mention this potentially serious problem that you are not going to be able to ignore and will have to spend extra time dealing with’, one late arrival (not her fault, in all fairness – she got caught in a traffic jam), two referrals, and one please-expedite-this-patient’s-appointment letter.  It could have been a hell of a lot worse.  I finished surgery at 5.35 and finished off everything else shortly after six; I’ve had later departures than that on normal days.  I loaded my last few things into a bag, took the sunflower picture off the wall, took one last long look at the room I’d worked in for almost five years, said my last goodbyes to the other people in the building, and left.  And I’m done.

On Wednesday, I can start dealing with the learning curve I’ve got ahead of me – new patients, new computer system, new referral procedures, new hospitals to refer to, all in a building so large I should probably take a map, a compass, and three days’ rations with me every time I try to navigate it.  I can do all of that.  The great thing about tidying your desk, apart of course from having a tidy desk, is that after that you know you can do anything.

Somewhere in the middle of all this, I’m about to turn forty.  I haven’t actually had time to think about this very much what with all the other change going on, but it seemed worthy of passing mention.  It’s odd to think that this time ten years ago I was still a trainee GP commuting back and forth to a long-distance boyfriend who I hoped would turn out to be the one for me.  Ten years, two postgraduate qualifications, two jobs, one wedding and two children later, I can say that it’s been a darned good decade.

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Filed under I think this line's mostly filler, The doctor is OUT. To lunch.

…the final…

Well, despite the whole business with the computer going down over the weekend when I was trying to catch up, and despite me getting in to work to discover that the head receptionist and the health care assistant were both off sick, and despite the failing fluorescent light in my room that has been flickering on and off all day in seizure-inducing fashion… I have, in fact, had a very reasonable day.  And, by 2.36 p.m. this afternoon, I printed off the last prescription, completed the last pending comment in a patient's notes, and pronounced myself caught up.  I went for a walk to celebrate.

(One item that I missed from the list of things that were personal and important enough to me to leave on my desk right through to the end was my Edward Monkton desk calendar, an endearingly quirky set of cartoons and comments about life.  June's comment is "The little bags of magic say there is NOTHING that they cannot do."  It has been my inspiration for the past few days, and I am now beginning to believe it.)

I have eleven patients left to see today (one of them has a double appointment booked), and I am not underestimating the potential of the afternoon surgery to wreak utter havoc on the day.  But I have the satisfaction of knowing that, for once in my life, I enter the fray with a clean slate, fully caught up.

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Filed under The doctor is OUT. To lunch.

And so I face…

For some weeks now, people have been asking me when I’m due to start the new job and then drawing in their breath on hearing that the answer is two days after I finish the old job.  So soon! they exclaim.  No time off in between?  I have to admit to being a bit baffled by this viewpoint; if I didn’t have this job and was simply turning up for my current one as usual on Wednesday, would anyone be amazed that I hadn’t taken some arbitrary break to recuperate?

It’s not time off after this job ends that I’ve been feeling in need of, but time off to catch up before it ends.  I had this whole grand plan as to how the final weeks would go – spare moments during days in work would be spent catching up on the things requiring my physical presence (my inbox, my desk, phone calls), and evenings would be spent catching up on letters (we have the GettomyPC programme, which lets us log in in the evenings), thus bringing me to this weekend with only a couple of days’ worth of letters to do, which I would then catch up on over the weekend, leaving me able to walk in on Monday with a clean slate and only having to do whatever came up on Monday before leaving.  Which might, of course, still be enough to keep me working late, but at least hopefully not too late.  I’m closer to that plan than I’d expected, but it’s been darned hard work.

One hitch has been work’s computer system crashing over the Bank Holiday weekend, putting a severe crimp in my plans to catch up on the long list of letters that had built up over the previous two days.  I shrugged at Fate’s vagaries, did as much as I could from memory and from Docman (the system for storing the hospital letters, fortunately separate from the one we use for consultations and not subject to its many nosedives), and determinedly fought the to-do list back down to nothing on the Tuesday and Wednesday evenings.  The other hitch was our drastic current state of understaffedness.  On Thursday, I had about twenty minutes to work on clearing my inbox before having to deal with a pile of prescriptions that took over an hour to work through, a morning surgery that went on until almost two in the afternoon, and two visits and multiple phone calls before having to drive over to our branch surgery and start afternoon surgery there almost an hour late.  Things then calmed down enough that I did just barely manage to at least get the results and incoming letters looked at before leaving, but I was further from getting everything else cleared than I had been when I started the day.

(This may be an apt moment to mention that it occurred to me recently that I hadn’t actually seen any prospective candidates for my job being shown round or introduced to me at any point, and that the evidence appeared to point to the conclusion that the practice wasn’t actually replacing me.  I inquired about this when I ran across the practice manager and assistant manager on the Thursday, and they exchanged somewhat blank glances, apparently trying to remember whether they had at any time in the past three months gone through the process of advertising the job, interviewing prospective applicants, and appointing one to start next week and whether this might simply have temporarily slipped their minds.  I think we can take it that this is a ‘no’, so it looks as though my already overworked colleagues are going to have to somehow struggle on with one more full-time member of staff gone, and how in blue bloody blazes the manager and assistant manager imagine that’s going to happen given the current state of affairs I can’t begin to imagine.  I’m deeply glad that it will no longer be my problem, but I don’t half feel sorry for the people still there who are somehow going to have to deal with it all.)

On Thursday evening, I logged on and caught up on as many more referral letters as I could (they had built up again during the day.  Considerably.)  On Friday I got in shortly after seven in the morning, left at almost six in the evening, and spent almost every minute I could squeeze around consultation time in the intervening near-eleven hours on clearing the things I had to clear.  And I did it.  Just before leaving I made the final phone call that let me drop a message into the pile for shredding, cleared the last few extraneous pieces of paper from the last pile on my desk, and left with five years worth of random bits and pieces in my car and a (relatively) tidy desk.  The last was what really brought it home to me; this is it, for real, for good.  When I next make that journey home, it’ll be the last time.  I logged on again that evening to work through more of the referrals, spent Saturday in a comfortable glow of achievement/haze of sleep deprivation, and logged on on Saturday evening to find the system had crashed again.  Of course.  I tried to get through to the practice manager several times today, but with no luck, and the assistant manager is on holiday, so the last few referrals remain undone.  It’s only twenty or thirty minutes worth of work, but that’s going to be enough to be somewhat annoying if I end up having to do it after work when I’m supposed to be leaving.  So be it; quantum in me fuit.

I’ve left the essentials at work, plus the few things that were enough of me that I wanted them to stay right up until the end.  The electronic doodad with the photos of the kids on that Barry gave me for my birthday a year or two back; the belatedly hung sunflower picture; my Edward Monkton desk calendar; the miniature globe that I spin to distract fractious babies for the few minutes it takes to listen to their chests; the tube of bubble mixture I used to use for the same purpose (one of the things I’ve stopped doing in recent years, as my life got busier and more rushed); my portable blood pressure cuff, my box of Kleenex, the soap substitute I use to spare my skin, my Vaseline bottle.  In a lifetime ruled by extraneous junk I never seem able to clear, it’s good to have a moment in which part of my life is boiled down to its essentials.

I’ve left jobs before; plenty of them.  In SHO years, it’s the way things work – a standard training post lasts six months, occasionally a year if you’re really up for commitment.  I was an SHO longer than most, rambling around the different specialties to gain experience in as many as I could before settling into GP-dom, and so for years of my life I was starting jobs with the end date already fixed for the not-so-distant future.  Then there was my first GP job, where I effectively only found out in retrospect that I’d left.  (I went on maternity leave, interviewed successfully for my current job while I was away, got offered the job just before I was due back at the one I had at the time, and went back only to work out my three months’ notice.  Since I was working for a PCT and not for an actual practice, they decided not to bother sending me back to the practice I was at just for three months, and sent me to a different one instead, so I found my departure on maternity leave rather unexpectedly converted into a permanent one.  I always felt sorry for the many regular patients of mine whom I’d assured in all good faith that I’d be back.)  Then there was the three-month post at an understaffed, overworked practice that the PCT had me do to work out my notice and that I left with no regrets whatsoever, and then, of course, there was this one.  At a few weeks short of five years, it is (albeit only by a few months) my current record time spent in employment at one place, and the first long-term job I’ve ever left in the foreknowledge that I was going to do so.  It has been, for all its faults, a damn good job, and I’ve enjoyed doing it.  And now, I’m ready – bar a few remaining referral letters – to leave it and move on to life’s next adventure.

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Filed under The doctor is OUT. To lunch.