Commentary

While every day seems to bring extraordinary new advances in science – robotic surgery, individually targeted medications, and even gene therapy – there are many people who currently approach the science of medicine with skepticism.

While it is the right of legally competent adults in a free society to chose how best to care for their own health, to explore holistic or alternative therapies, or avoid medicine altogether, it is more complex when they are skeptical of accepted medical practice in managing the health of their children. For those parents who trust you enough to bring their children to you for care but remain skeptical of vaccines or other treatments, you have an opportunity to work with that trust and engage in a discussion so that they might reconsider their position on valuable and even life-saving treatments for their children.

Wavebreakmedia/Thinkstock

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics at Harvard Medical School, Boston. Email them at [email protected].

While every day seems to bring extraordinary new advances in science – robotic surgery, individually targeted medications, and even gene therapy – there are many people who currently approach the science of medicine with skepticism.

While it is the right of legally competent adults in a free society to chose how best to care for their own health, to explore holistic or alternative therapies, or avoid medicine altogether, it is more complex when they are skeptical of accepted medical practice in managing the health of their children. For those parents who trust you enough to bring their children to you for care but remain skeptical of vaccines or other treatments, you have an opportunity to work with that trust and engage in a discussion so that they might reconsider their position on valuable and even life-saving treatments for their children.

Wavebreakmedia/Thinkstock

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics at Harvard Medical School, Boston. Email them at [email protected].

While every day seems to bring extraordinary new advances in science – robotic surgery, individually targeted medications, and even gene therapy – there are many people who currently approach the science of medicine with skepticism.

While it is the right of legally competent adults in a free society to chose how best to care for their own health, to explore holistic or alternative therapies, or avoid medicine altogether, it is more complex when they are skeptical of accepted medical practice in managing the health of their children. For those parents who trust you enough to bring their children to you for care but remain skeptical of vaccines or other treatments, you have an opportunity to work with that trust and engage in a discussion so that they might reconsider their position on valuable and even life-saving treatments for their children.

Wavebreakmedia/Thinkstock

Dr. Swick is an attending psychiatrist in the division of child psychiatry at Massachusetts General Hospital, Boston, and director of the Parenting at a Challenging Time (PACT) Program at the Vernon Cancer Center at Newton Wellesley Hospital, also in Boston. Dr. Jellinek is professor emeritus of psychiatry and pediatrics at Harvard Medical School, Boston. Email them at [email protected].

You may not realize it, but as you navigated through this morning’s hospital rounds and your busy office schedule, some of what you did and how you did it was the result of the pioneering work of Boston-based pediatrician T. Berry Brazelton, MD, who died March 13, 2018, at the age of 99.

You probably found the newborn you needed to examine in his mother’s hospital room. The 3-year-old in the croup tent was sharing his room with his father, who was sleeping on a cot at his crib side, and three out of the first four patients you saw in your office had been breastfed. These scenarios would have been unheard of 50 years ago. But Dr. Brazelton’s voice was the most widely heard, yet gentlest and persuasive in support of rooming-in and breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

You may not realize it, but as you navigated through this morning’s hospital rounds and your busy office schedule, some of what you did and how you did it was the result of the pioneering work of Boston-based pediatrician T. Berry Brazelton, MD, who died March 13, 2018, at the age of 99.

You probably found the newborn you needed to examine in his mother’s hospital room. The 3-year-old in the croup tent was sharing his room with his father, who was sleeping on a cot at his crib side, and three out of the first four patients you saw in your office had been breastfed. These scenarios would have been unheard of 50 years ago. But Dr. Brazelton’s voice was the most widely heard, yet gentlest and persuasive in support of rooming-in and breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

You may not realize it, but as you navigated through this morning’s hospital rounds and your busy office schedule, some of what you did and how you did it was the result of the pioneering work of Boston-based pediatrician T. Berry Brazelton, MD, who died March 13, 2018, at the age of 99.

You probably found the newborn you needed to examine in his mother’s hospital room. The 3-year-old in the croup tent was sharing his room with his father, who was sleeping on a cot at his crib side, and three out of the first four patients you saw in your office had been breastfed. These scenarios would have been unheard of 50 years ago. But Dr. Brazelton’s voice was the most widely heard, yet gentlest and persuasive in support of rooming-in and breastfeeding.

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at [email protected].

This past year has seen an incredible transformation in our awareness and understanding of the extent of sexual harassment and assault in our society. The #metoo campaign and the brave women throughout the country who have come out and told us their stories have truly made a difference.

For years, I, and many other pediatricians like me, have counseled teenage girls on how to stay safe as they prepare to enter college and universities. So many times, I have mentioned the shocking statistics on rape and sexual assault in college. I have cautioned these young women on how to stay safe, to stay close to their girlfriends, to not accept drinks from other people, and if drinking, not to drink so much that they don’t know what is going on around them … and so on and so forth with many dos and don’ts.

But here is something I only recently noticed: In the last 18 years of practice, my counsel to the boys was limited to how to stay safe, protect themselves against sexually transmitted infections, and how to avoid pregnancy. It did not cross my mind to counsel the teenage boys on their respective dos and don’ts, especially when it comes to their behavior with women. For example, stern advice on how to respect women, that only yes means yes, and frankly how to make sure they don’t become sexual harassers or worse.

I have questioned myself since then, wondering if I was alone with this oversight. I asked several other pediatricians as well to see if they had spoken about sexual harassment and assault in this context with their teenage male patients. The vast majority had the same experience as I did. They had all counseled the girls on how to protect themselves from becoming victims, but somehow not the boys (or girls for that matter) on how to help them not become the aggressors.

Courtesy Bilal Zuberi

Dr. Rimawi is a pediatrician in private practice in Atherton, Calif. Email her at [email protected].

This past year has seen an incredible transformation in our awareness and understanding of the extent of sexual harassment and assault in our society. The #metoo campaign and the brave women throughout the country who have come out and told us their stories have truly made a difference.

For years, I, and many other pediatricians like me, have counseled teenage girls on how to stay safe as they prepare to enter college and universities. So many times, I have mentioned the shocking statistics on rape and sexual assault in college. I have cautioned these young women on how to stay safe, to stay close to their girlfriends, to not accept drinks from other people, and if drinking, not to drink so much that they don’t know what is going on around them … and so on and so forth with many dos and don’ts.

But here is something I only recently noticed: In the last 18 years of practice, my counsel to the boys was limited to how to stay safe, protect themselves against sexually transmitted infections, and how to avoid pregnancy. It did not cross my mind to counsel the teenage boys on their respective dos and don’ts, especially when it comes to their behavior with women. For example, stern advice on how to respect women, that only yes means yes, and frankly how to make sure they don’t become sexual harassers or worse.

I have questioned myself since then, wondering if I was alone with this oversight. I asked several other pediatricians as well to see if they had spoken about sexual harassment and assault in this context with their teenage male patients. The vast majority had the same experience as I did. They had all counseled the girls on how to protect themselves from becoming victims, but somehow not the boys (or girls for that matter) on how to help them not become the aggressors.

Courtesy Bilal Zuberi

Dr. Rimawi is a pediatrician in private practice in Atherton, Calif. Email her at [email protected].

This past year has seen an incredible transformation in our awareness and understanding of the extent of sexual harassment and assault in our society. The #metoo campaign and the brave women throughout the country who have come out and told us their stories have truly made a difference.

For years, I, and many other pediatricians like me, have counseled teenage girls on how to stay safe as they prepare to enter college and universities. So many times, I have mentioned the shocking statistics on rape and sexual assault in college. I have cautioned these young women on how to stay safe, to stay close to their girlfriends, to not accept drinks from other people, and if drinking, not to drink so much that they don’t know what is going on around them … and so on and so forth with many dos and don’ts.

But here is something I only recently noticed: In the last 18 years of practice, my counsel to the boys was limited to how to stay safe, protect themselves against sexually transmitted infections, and how to avoid pregnancy. It did not cross my mind to counsel the teenage boys on their respective dos and don’ts, especially when it comes to their behavior with women. For example, stern advice on how to respect women, that only yes means yes, and frankly how to make sure they don’t become sexual harassers or worse.

I have questioned myself since then, wondering if I was alone with this oversight. I asked several other pediatricians as well to see if they had spoken about sexual harassment and assault in this context with their teenage male patients. The vast majority had the same experience as I did. They had all counseled the girls on how to protect themselves from becoming victims, but somehow not the boys (or girls for that matter) on how to help them not become the aggressors.

Courtesy Bilal Zuberi

Dr. Rimawi is a pediatrician in private practice in Atherton, Calif. Email her at [email protected].

The evening before the March For Our Lives rally in Washington, I was hard at work on my sign. Making a statement is important, but at the Women’s March last January, I discovered that a sign was invaluable for keeping friends together in a crowd. Since my Women’s March sign read “Make America Kind Again,” I opted to keep with the theme, and I created a “Make America Safe Again” sign for gun control. My daughter looked at my sign skeptically. “It’s too vague and nondirective,” she declared. Now challenged, I added the following directives: “Universal Background Checks,” “Ban Assault Weapons,” and “Smart Guns.” My sign was now complete.

I was surprised when my daughter – our family Jeopardy! whiz – asked, “What’s a smart gun?” When we arrived to join friends, their daughter – a doctoral student – also looked at the sign and asked me what a smart gun is. I explained to both young women that a smart gun – like an iPhone – relies on a biometric such as a fingerprint so that it can be used only by authorized users. This technology would reduce the flow of firearms to illegal owners, prevent accidental discharge by children, protect rightful owners and law enforcement officers from having their own weapons used against them by criminals, and decrease the number of suicides by family members of gun owners. In my state of Maryland, there have been two school shootings, one as recently as March 20, and both were committed by boys who took a parent’s firearm to school.

Courtesy Dr. Dinah Miller

We arrived at the rally and found a spot in front of the Newseum, with two jumbotrons in sight, right in the middle of the crowd. The young people who spoke were inspirational. Regardless of one’s political views or thoughts on gun control, they were bright, articulate, fearless, passionate, and determined. The show was stolen by Naomi Wadler, a precocious 11-year-old girl who is destined to be a member of Congress (if not president) one day, and by Dr. Martin Luther King Jr.’s 9-year-old granddaughter, Yolanda Renee King.

The rest of the speakers were teenagers, all of whom had lost someone to gunfire. There were speakers from Parkland, Fla., who talked about the raw losses they were feeling, and the student who wasn’t celebrating his 18th birthday on March 24. Matthew Soto from Newtown, Conn., talked about losing his sister, a first-grade teacher, in the Sandy Hook shooting.

But the rally wasn’t just about mass murders and school shootings: Zion Kelly talked about the death of his twin, a teen who was killed when he stopped at a convenience store on the way home from school in Washington, only to have his promising life snuffed out during a holdup. We heard about shootings in the bullet-riddled streets of Chicago and Los Angeles and the toll they have taken. The losses to gun violence have been felt most strongly in communities of color. While it was mentioned that the majority of gun deaths are suicides, there were no speakers from families of people who died from suicide. The final speaker was Emma Gonzalez, a young woman from Parkland who took the stage for 6 minutes and 20 seconds - the duration of the shooter’s rampage - and closed with a powerful moment of silence.*  The rally closed with a performance of Bob Dylan’s “The Times They Are a-Changin’ ” by Jennifer Hudson, whose mother, brother, and nephew were murdered by a gunman.

The teens talked about what changes they wanted to see enacted. They talked about closing loopholes to background checks, and I was pleased that one young man specifically mentioned keeping guns from those who are violent, but did not mention mental illness as a reason to block gun ownership. A call to resume a ban on assault weapons was made repeatedly as was a call to raise the age (to 21) at which an individual can purchase a gun. Military-style weapons are not necessary for hunting or self-defense, and they enable the rapid-fire assassinations we have seen in mass shootings, so they remain an easy target of gun control advocacy. But in terms of numbers, these firearms are responsible for a small fraction of gun deaths. I was surprised, but the teens did not mention “smart gun” legislation as a way to reduce gun deaths.

Guns, and gun deaths, are a part of American society. While the majority of Americans favor stronger regulation of gun ownership, legislation that would end gun ownership is not likely to go anywhere. Smart guns, however, are different. Forty percent of polled gun owners have said they would swap their firearm for a smart firearm. So given the appeal of a firearm that can’t be diverted or stolen, used against the owner, discharged accidentally by a child, or used for suicide or homicide by a distressed family member, why don’t these weapons exist for use by the American people? Numerous technologies exist, dating back to 1975, and the first fingerprint-enabled gun was invented by Kai Kloepfer, an 18-year-old high school student, in 2015. People want these guns and the protections they offer, yet they have never been produced and made available to either the American public or to our law enforcement officers.

So where are these firearms, and why aren’t our Parkland teens asking for them? The answer to the first part of that question lies with the National Rifle Association (NRA) and the state of New Jersey. In 2003, New Jersey passed the Childproof Handgun bill, which requires that all guns sold in the state be smart guns within 3 years of their availability. The NRA has vigorously opposed any legislation that would require all guns to be smart guns. Because the availability of these weapons would trigger the New Jersey bill, California and Maryland have been prevented from importing smart firearms from a German company. Perhaps, however, New Jersey does not need to bear all the blame; in 1999, 4 years before the passage of the bill, the NRA and its members boycotted Smith & Wesson when the gun manufacturer revealed plans to develop a smart gun for the government. The NRA’s public stance is that it does not oppose smart guns for those who want them, but it opposes legislation that would eliminate the sale of conventional firearms. The organization has voiced concerns that technology fails and that it potentially slows down firing the weapon. It doesn’t talk about dead toddlers, or about police officers who’ve been killed when their weapons were taken from them.

As for the Parkland students, I don’t know why they aren’t asking for smart gun technology while they have the attention of the country. Perhaps they, like the young women I was with, don’t know it’s an option. Perhaps it’s too removed from the issue of mass murders and an assault weapon ban feels more attainable. Or perhaps the NRA’s mission has too much of a stronghold in Florida. I don’t know why they aren’t asking for smart gun production, but I know they should be.

*Correction, 3/27/2018: An earlier version of this story misstated the duration of Emma Gonzalez's moment of silence.

Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press), 2016. She practices in Baltimore.

The evening before the March For Our Lives rally in Washington, I was hard at work on my sign. Making a statement is important, but at the Women’s March last January, I discovered that a sign was invaluable for keeping friends together in a crowd. Since my Women’s March sign read “Make America Kind Again,” I opted to keep with the theme, and I created a “Make America Safe Again” sign for gun control. My daughter looked at my sign skeptically. “It’s too vague and nondirective,” she declared. Now challenged, I added the following directives: “Universal Background Checks,” “Ban Assault Weapons,” and “Smart Guns.” My sign was now complete.

I was surprised when my daughter – our family Jeopardy! whiz – asked, “What’s a smart gun?” When we arrived to join friends, their daughter – a doctoral student – also looked at the sign and asked me what a smart gun is. I explained to both young women that a smart gun – like an iPhone – relies on a biometric such as a fingerprint so that it can be used only by authorized users. This technology would reduce the flow of firearms to illegal owners, prevent accidental discharge by children, protect rightful owners and law enforcement officers from having their own weapons used against them by criminals, and decrease the number of suicides by family members of gun owners. In my state of Maryland, there have been two school shootings, one as recently as March 20, and both were committed by boys who took a parent’s firearm to school.

Courtesy Dr. Dinah Miller

We arrived at the rally and found a spot in front of the Newseum, with two jumbotrons in sight, right in the middle of the crowd. The young people who spoke were inspirational. Regardless of one’s political views or thoughts on gun control, they were bright, articulate, fearless, passionate, and determined. The show was stolen by Naomi Wadler, a precocious 11-year-old girl who is destined to be a member of Congress (if not president) one day, and by Dr. Martin Luther King Jr.’s 9-year-old granddaughter, Yolanda Renee King.

The rest of the speakers were teenagers, all of whom had lost someone to gunfire. There were speakers from Parkland, Fla., who talked about the raw losses they were feeling, and the student who wasn’t celebrating his 18th birthday on March 24. Matthew Soto from Newtown, Conn., talked about losing his sister, a first-grade teacher, in the Sandy Hook shooting.

But the rally wasn’t just about mass murders and school shootings: Zion Kelly talked about the death of his twin, a teen who was killed when he stopped at a convenience store on the way home from school in Washington, only to have his promising life snuffed out during a holdup. We heard about shootings in the bullet-riddled streets of Chicago and Los Angeles and the toll they have taken. The losses to gun violence have been felt most strongly in communities of color. While it was mentioned that the majority of gun deaths are suicides, there were no speakers from families of people who died from suicide. The final speaker was Emma Gonzalez, a young woman from Parkland who took the stage for 6 minutes and 20 seconds - the duration of the shooter’s rampage - and closed with a powerful moment of silence.*  The rally closed with a performance of Bob Dylan’s “The Times They Are a-Changin’ ” by Jennifer Hudson, whose mother, brother, and nephew were murdered by a gunman.

The teens talked about what changes they wanted to see enacted. They talked about closing loopholes to background checks, and I was pleased that one young man specifically mentioned keeping guns from those who are violent, but did not mention mental illness as a reason to block gun ownership. A call to resume a ban on assault weapons was made repeatedly as was a call to raise the age (to 21) at which an individual can purchase a gun. Military-style weapons are not necessary for hunting or self-defense, and they enable the rapid-fire assassinations we have seen in mass shootings, so they remain an easy target of gun control advocacy. But in terms of numbers, these firearms are responsible for a small fraction of gun deaths. I was surprised, but the teens did not mention “smart gun” legislation as a way to reduce gun deaths.

Guns, and gun deaths, are a part of American society. While the majority of Americans favor stronger regulation of gun ownership, legislation that would end gun ownership is not likely to go anywhere. Smart guns, however, are different. Forty percent of polled gun owners have said they would swap their firearm for a smart firearm. So given the appeal of a firearm that can’t be diverted or stolen, used against the owner, discharged accidentally by a child, or used for suicide or homicide by a distressed family member, why don’t these weapons exist for use by the American people? Numerous technologies exist, dating back to 1975, and the first fingerprint-enabled gun was invented by Kai Kloepfer, an 18-year-old high school student, in 2015. People want these guns and the protections they offer, yet they have never been produced and made available to either the American public or to our law enforcement officers.

So where are these firearms, and why aren’t our Parkland teens asking for them? The answer to the first part of that question lies with the National Rifle Association (NRA) and the state of New Jersey. In 2003, New Jersey passed the Childproof Handgun bill, which requires that all guns sold in the state be smart guns within 3 years of their availability. The NRA has vigorously opposed any legislation that would require all guns to be smart guns. Because the availability of these weapons would trigger the New Jersey bill, California and Maryland have been prevented from importing smart firearms from a German company. Perhaps, however, New Jersey does not need to bear all the blame; in 1999, 4 years before the passage of the bill, the NRA and its members boycotted Smith & Wesson when the gun manufacturer revealed plans to develop a smart gun for the government. The NRA’s public stance is that it does not oppose smart guns for those who want them, but it opposes legislation that would eliminate the sale of conventional firearms. The organization has voiced concerns that technology fails and that it potentially slows down firing the weapon. It doesn’t talk about dead toddlers, or about police officers who’ve been killed when their weapons were taken from them.

As for the Parkland students, I don’t know why they aren’t asking for smart gun technology while they have the attention of the country. Perhaps they, like the young women I was with, don’t know it’s an option. Perhaps it’s too removed from the issue of mass murders and an assault weapon ban feels more attainable. Or perhaps the NRA’s mission has too much of a stronghold in Florida. I don’t know why they aren’t asking for smart gun production, but I know they should be.

*Correction, 3/27/2018: An earlier version of this story misstated the duration of Emma Gonzalez's moment of silence.

Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press), 2016. She practices in Baltimore.

The evening before the March For Our Lives rally in Washington, I was hard at work on my sign. Making a statement is important, but at the Women’s March last January, I discovered that a sign was invaluable for keeping friends together in a crowd. Since my Women’s March sign read “Make America Kind Again,” I opted to keep with the theme, and I created a “Make America Safe Again” sign for gun control. My daughter looked at my sign skeptically. “It’s too vague and nondirective,” she declared. Now challenged, I added the following directives: “Universal Background Checks,” “Ban Assault Weapons,” and “Smart Guns.” My sign was now complete.

I was surprised when my daughter – our family Jeopardy! whiz – asked, “What’s a smart gun?” When we arrived to join friends, their daughter – a doctoral student – also looked at the sign and asked me what a smart gun is. I explained to both young women that a smart gun – like an iPhone – relies on a biometric such as a fingerprint so that it can be used only by authorized users. This technology would reduce the flow of firearms to illegal owners, prevent accidental discharge by children, protect rightful owners and law enforcement officers from having their own weapons used against them by criminals, and decrease the number of suicides by family members of gun owners. In my state of Maryland, there have been two school shootings, one as recently as March 20, and both were committed by boys who took a parent’s firearm to school.

Courtesy Dr. Dinah Miller

We arrived at the rally and found a spot in front of the Newseum, with two jumbotrons in sight, right in the middle of the crowd. The young people who spoke were inspirational. Regardless of one’s political views or thoughts on gun control, they were bright, articulate, fearless, passionate, and determined. The show was stolen by Naomi Wadler, a precocious 11-year-old girl who is destined to be a member of Congress (if not president) one day, and by Dr. Martin Luther King Jr.’s 9-year-old granddaughter, Yolanda Renee King.

The rest of the speakers were teenagers, all of whom had lost someone to gunfire. There were speakers from Parkland, Fla., who talked about the raw losses they were feeling, and the student who wasn’t celebrating his 18th birthday on March 24. Matthew Soto from Newtown, Conn., talked about losing his sister, a first-grade teacher, in the Sandy Hook shooting.

But the rally wasn’t just about mass murders and school shootings: Zion Kelly talked about the death of his twin, a teen who was killed when he stopped at a convenience store on the way home from school in Washington, only to have his promising life snuffed out during a holdup. We heard about shootings in the bullet-riddled streets of Chicago and Los Angeles and the toll they have taken. The losses to gun violence have been felt most strongly in communities of color. While it was mentioned that the majority of gun deaths are suicides, there were no speakers from families of people who died from suicide. The final speaker was Emma Gonzalez, a young woman from Parkland who took the stage for 6 minutes and 20 seconds - the duration of the shooter’s rampage - and closed with a powerful moment of silence.*  The rally closed with a performance of Bob Dylan’s “The Times They Are a-Changin’ ” by Jennifer Hudson, whose mother, brother, and nephew were murdered by a gunman.

The teens talked about what changes they wanted to see enacted. They talked about closing loopholes to background checks, and I was pleased that one young man specifically mentioned keeping guns from those who are violent, but did not mention mental illness as a reason to block gun ownership. A call to resume a ban on assault weapons was made repeatedly as was a call to raise the age (to 21) at which an individual can purchase a gun. Military-style weapons are not necessary for hunting or self-defense, and they enable the rapid-fire assassinations we have seen in mass shootings, so they remain an easy target of gun control advocacy. But in terms of numbers, these firearms are responsible for a small fraction of gun deaths. I was surprised, but the teens did not mention “smart gun” legislation as a way to reduce gun deaths.

Guns, and gun deaths, are a part of American society. While the majority of Americans favor stronger regulation of gun ownership, legislation that would end gun ownership is not likely to go anywhere. Smart guns, however, are different. Forty percent of polled gun owners have said they would swap their firearm for a smart firearm. So given the appeal of a firearm that can’t be diverted or stolen, used against the owner, discharged accidentally by a child, or used for suicide or homicide by a distressed family member, why don’t these weapons exist for use by the American people? Numerous technologies exist, dating back to 1975, and the first fingerprint-enabled gun was invented by Kai Kloepfer, an 18-year-old high school student, in 2015. People want these guns and the protections they offer, yet they have never been produced and made available to either the American public or to our law enforcement officers.

So where are these firearms, and why aren’t our Parkland teens asking for them? The answer to the first part of that question lies with the National Rifle Association (NRA) and the state of New Jersey. In 2003, New Jersey passed the Childproof Handgun bill, which requires that all guns sold in the state be smart guns within 3 years of their availability. The NRA has vigorously opposed any legislation that would require all guns to be smart guns. Because the availability of these weapons would trigger the New Jersey bill, California and Maryland have been prevented from importing smart firearms from a German company. Perhaps, however, New Jersey does not need to bear all the blame; in 1999, 4 years before the passage of the bill, the NRA and its members boycotted Smith & Wesson when the gun manufacturer revealed plans to develop a smart gun for the government. The NRA’s public stance is that it does not oppose smart guns for those who want them, but it opposes legislation that would eliminate the sale of conventional firearms. The organization has voiced concerns that technology fails and that it potentially slows down firing the weapon. It doesn’t talk about dead toddlers, or about police officers who’ve been killed when their weapons were taken from them.

As for the Parkland students, I don’t know why they aren’t asking for smart gun technology while they have the attention of the country. Perhaps they, like the young women I was with, don’t know it’s an option. Perhaps it’s too removed from the issue of mass murders and an assault weapon ban feels more attainable. Or perhaps the NRA’s mission has too much of a stronghold in Florida. I don’t know why they aren’t asking for smart gun production, but I know they should be.

*Correction, 3/27/2018: An earlier version of this story misstated the duration of Emma Gonzalez's moment of silence.

Dr. Miller is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Psychiatric Care” (Baltimore: Johns Hopkins University Press), 2016. She practices in Baltimore.

This is the mantra that the world hears when they call most, if not all, hospitals and medical clinics for the symptomatic relief of a myriad of health care complaints. Exactly what is the definition of an emergency is uncertain. We all could include severe chest pain, shortness of breath or sudden collapse or loss of consciousness.

To a patient, an emergency might just include the pressing need to speak to their doctor about the occurrence of symptoms and or anxieties that suddenly have occurred. In the past, before the telephone was invented, a friend or family member was sent by horseback or a Ford V8 to find the local doctor. With the advent of the telephone, doctors actually listed their number in a phone directory to facilitate contact with their patient.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

This is the mantra that the world hears when they call most, if not all, hospitals and medical clinics for the symptomatic relief of a myriad of health care complaints. Exactly what is the definition of an emergency is uncertain. We all could include severe chest pain, shortness of breath or sudden collapse or loss of consciousness.

To a patient, an emergency might just include the pressing need to speak to their doctor about the occurrence of symptoms and or anxieties that suddenly have occurred. In the past, before the telephone was invented, a friend or family member was sent by horseback or a Ford V8 to find the local doctor. With the advent of the telephone, doctors actually listed their number in a phone directory to facilitate contact with their patient.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

This is the mantra that the world hears when they call most, if not all, hospitals and medical clinics for the symptomatic relief of a myriad of health care complaints. Exactly what is the definition of an emergency is uncertain. We all could include severe chest pain, shortness of breath or sudden collapse or loss of consciousness.

To a patient, an emergency might just include the pressing need to speak to their doctor about the occurrence of symptoms and or anxieties that suddenly have occurred. In the past, before the telephone was invented, a friend or family member was sent by horseback or a Ford V8 to find the local doctor. With the advent of the telephone, doctors actually listed their number in a phone directory to facilitate contact with their patient.

Dr. Goldstein, medical editor of Cardiology News, is professor of medicine at Wayne State University and division head emeritus of cardiovascular medicine at Henry Ford Hospital, both in Detroit. He is on data safety monitoring committees for the National Institutes of Health and several pharmaceutical companies.

There is an increased focus on reducing the costs of health care delivery, and one major driver of surgical cost is length of hospitalization. A minimally invasive surgical approach to hysterectomy is a strategy that significantly enhances recovery and shortens hospital stay, although many patients who can safely be considered for same-day discharge (SDD), including many with cancer, are still admitted to the hospital overnight. Much has been published on the predictors and pathways for successful same-day discharge after minimally invasive hysterectomy, and in this column we will review how to best predict who is a good candidate for SDD and how to optimize the success of this approach with respect to safety and patient satisfaction.

What are the benefits to SDD?

Certainly, decreased hospitalization costs are an attractive feature of SDD following hysterectomy, although surgeons should also be mindful that patient-centered outcomes, such as pain control, managing nausea, and patient satisfaction, also are considered with equal emphasis. Several studies have shown that, in appropriate candidates and when proactive pathways are used, patient satisfaction is preserved with SDD following hysterectomy.¹

Choosing patient candidates

Same day discharge is most successfully accomplished in patients of good general baseline health.² Diabetic patients, particularly those on insulin, are generally not good candidates for SDD because it is important to monitor and intervene in blood glucose changes that are influenced by a nothing-by-mouth status and surgical stress. We recommend observing patients overnight with a history of pulmonary disease who may have transient increased postoperative O₂ needs. Similarly, patients with significant cardiac disease (including heart failure and coronary disease) may benefit from prolonged overnight observation.

Particular caution should be paid to patients with obstructive sleep apnea, which may be occult but anticipated in patients with very high body mass indexes (greater than 40 kg/m²). General anesthetic drugs, the trauma of intubation, and opioids all couple with the underlying airway compromise such that these patients are at risk for postoperative apnea, which, in severe cases, can result in anoxia and death. These patients should be considered for continuous pulse-ox monitoring for at least 12-24 hours postoperatively and are not good candidates for same-day discharge.

Patients who have baseline anticoagulation that has been stopped or bridged preoperatively should have prolonged observation with recheck of their postoperative hemoglobin prior to discharge.

Patients who live alone or are very elderly with baseline frailty are poor candidates for SDD and may benefit from nursing observation overnight while they metabolize their anesthesia. Patients who have chronic opioid dependency present a greater challenge to control postoperative pain; these patients are generally less good candidates for SDD.

Studies have shown that the indication for the procedure (for example, cancer with staging, fibroids, endometriosis) is less critical in determining who is a good candidate for SDD.³ However, successful SDD rates are highest in more straightforward cases with few or no prior surgeries, small uteri (less than 14 weeks), a surgical duration of less than 3 hours, and a surgical start time before 2 p.m. Longer, more complex cases are typically associated with more blood loss, higher risk for occult complications, and more time under anesthesia (and in Trendelenburg), which can exacerbate airway edema. In preparation for such cases, it might be wise to prepare patients for the possibility that they may not be good candidates for discharge on the same day. In general, most SDD pathways exclude patients with very high BMI (greater than 50 kg/m²) because of concern for airway patency and because these cases may be more complex with higher underlying risk. In addition, many of these patients have diabetes and require perioperative metabolic interventions.

Patient preparation

A key component to successful SDD is setting patient expectations. Patients should be informed at their preoperative visit that, unless there is an unexpected occurrence or response to the surgery, they will be discharged to home the same day. This allows them to prepare their home (including transportation needs) in advance. They should be provided with information about what to expect that first night after surgery (including potential residual drowsiness or nausea from anesthesia and immediate postoperative pain).

On the day of surgery, under the influence of anesthesia and pain medication, patients will have difficulty retaining complex discharge instructions. The preoperative visit is critically important because it’s the best time to provide them with this information, including postoperative activity limitations, wound and dressing care, and follow-up instructions. This is also the best time to provide prescriptions for postoperative pain, nausea, and constipation prophylaxis with detailed instructions about best use. Patients should be encouraged to fill these prescriptions preoperatively so that they have these medications on hand on the evening of their discharge.

Many programs utilize a combination of educational strategies (in person, written, video) to maximize the likelihood of retention.¹ It is also important to offer an opportunity for patients to ask questions about this information after they have received it (for example, by phoning the patients prior to their procedure).
 

Preoperative strategies

Intraoperative strategies

Consider in-and-out catheterization rather than placement of an indwelling catheter for anticipated short cases without complex bladder dissection.⁵ Minimize blood loss and maximally evacuate blood and clots with suction because hemoperitoneum can induce nausea and pain.

Pain from retained gas under the diaphragm can be reduced by bathing the diaphragms with 400 cc of dilute local anesthetic made by mixing 50 mL of 0.5% bupivacaine in 1000 mL normal saline prior to removal of pneumoperitoneum and while still in Trendelenburg. Ensure there is minimal retained intraperitoneal CO₂ at the completion of the surgery by asking the anesthesiologists to perform positive pressure ventilations prior to fascial closure. Consider injecting port sites (including the peritoneal and fascial layers) with a mixture of immediate and long-acting local anesthetics. Request that the anesthesia staff administer intraoperative doses of IV ketorolac, acetaminophen, and tramadol (in preference to opioids) and an aggressive perioperative cocktail of antiemetics.

Management in the recovery room

Surgeons should ensure that recovery room staff are well versed in the pathway for patients who are selected for SDD to ensure proactive implementation of analgesic and antiemetic regimens and to fast-track the various tasks and education required for discharge.⁵

Patients should be started on their home postoperative medication regimen in the recovery room, including an anti-inflammatory such as diclofenac, sublingual tramadol (in preference to an opioid, such as hydrocodone), docusate, and sennosides. IV opioids should be avoided because they can result in somnolence and nausea.

If placed intraoperatively, the Foley catheter should be removed early to allow adequate time to void. Backfilling the bladder prior to removal can hasten the urge to void and help objectively document completeness of evacuation. All patients should be seen by the anesthesiologist and/or surgeon prior to discharge.

For patients who are discharged same day, a follow-up phone call on postoperative day 1 is valuable to ensure that they have continued their successful postoperative transition to the home and to intervene early if there are concerns for patient satisfaction.

Dr. Rossi is an assistant professor in the division of gynecologic oncology at the University of North Carolina at Chapel Hill.

References

1. Fountain CR et al. Promoting same-day discharge for gynecologic oncology patients in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):932-9.

2. Rivard C et al. Factors influencing same-day hospital discharge and risk factors for readmission after robotic surgery in the gynecologic oncology patient population. J Minim Invasive Gynecol. 2015 Feb;22(2):219-26.

3. Lee SJ et al. The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications. Gynecol Oncol. 2014 Jun;133(3):552-5.

4. Elia N et al. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005 Dec;103(6):1296-304.

5. Donnez O et al. Low pain score after total laparoscopic hysterectomy and same-day discharge within less than 5 hours: Results of a prospective observational study. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1293-9.

There is an increased focus on reducing the costs of health care delivery, and one major driver of surgical cost is length of hospitalization. A minimally invasive surgical approach to hysterectomy is a strategy that significantly enhances recovery and shortens hospital stay, although many patients who can safely be considered for same-day discharge (SDD), including many with cancer, are still admitted to the hospital overnight. Much has been published on the predictors and pathways for successful same-day discharge after minimally invasive hysterectomy, and in this column we will review how to best predict who is a good candidate for SDD and how to optimize the success of this approach with respect to safety and patient satisfaction.

What are the benefits to SDD?

Certainly, decreased hospitalization costs are an attractive feature of SDD following hysterectomy, although surgeons should also be mindful that patient-centered outcomes, such as pain control, managing nausea, and patient satisfaction, also are considered with equal emphasis. Several studies have shown that, in appropriate candidates and when proactive pathways are used, patient satisfaction is preserved with SDD following hysterectomy.¹

Choosing patient candidates

Same day discharge is most successfully accomplished in patients of good general baseline health.² Diabetic patients, particularly those on insulin, are generally not good candidates for SDD because it is important to monitor and intervene in blood glucose changes that are influenced by a nothing-by-mouth status and surgical stress. We recommend observing patients overnight with a history of pulmonary disease who may have transient increased postoperative O₂ needs. Similarly, patients with significant cardiac disease (including heart failure and coronary disease) may benefit from prolonged overnight observation.

Particular caution should be paid to patients with obstructive sleep apnea, which may be occult but anticipated in patients with very high body mass indexes (greater than 40 kg/m²). General anesthetic drugs, the trauma of intubation, and opioids all couple with the underlying airway compromise such that these patients are at risk for postoperative apnea, which, in severe cases, can result in anoxia and death. These patients should be considered for continuous pulse-ox monitoring for at least 12-24 hours postoperatively and are not good candidates for same-day discharge.

Patients who have baseline anticoagulation that has been stopped or bridged preoperatively should have prolonged observation with recheck of their postoperative hemoglobin prior to discharge.

Patients who live alone or are very elderly with baseline frailty are poor candidates for SDD and may benefit from nursing observation overnight while they metabolize their anesthesia. Patients who have chronic opioid dependency present a greater challenge to control postoperative pain; these patients are generally less good candidates for SDD.

Studies have shown that the indication for the procedure (for example, cancer with staging, fibroids, endometriosis) is less critical in determining who is a good candidate for SDD.³ However, successful SDD rates are highest in more straightforward cases with few or no prior surgeries, small uteri (less than 14 weeks), a surgical duration of less than 3 hours, and a surgical start time before 2 p.m. Longer, more complex cases are typically associated with more blood loss, higher risk for occult complications, and more time under anesthesia (and in Trendelenburg), which can exacerbate airway edema. In preparation for such cases, it might be wise to prepare patients for the possibility that they may not be good candidates for discharge on the same day. In general, most SDD pathways exclude patients with very high BMI (greater than 50 kg/m²) because of concern for airway patency and because these cases may be more complex with higher underlying risk. In addition, many of these patients have diabetes and require perioperative metabolic interventions.

Patient preparation

A key component to successful SDD is setting patient expectations. Patients should be informed at their preoperative visit that, unless there is an unexpected occurrence or response to the surgery, they will be discharged to home the same day. This allows them to prepare their home (including transportation needs) in advance. They should be provided with information about what to expect that first night after surgery (including potential residual drowsiness or nausea from anesthesia and immediate postoperative pain).

On the day of surgery, under the influence of anesthesia and pain medication, patients will have difficulty retaining complex discharge instructions. The preoperative visit is critically important because it’s the best time to provide them with this information, including postoperative activity limitations, wound and dressing care, and follow-up instructions. This is also the best time to provide prescriptions for postoperative pain, nausea, and constipation prophylaxis with detailed instructions about best use. Patients should be encouraged to fill these prescriptions preoperatively so that they have these medications on hand on the evening of their discharge.

Many programs utilize a combination of educational strategies (in person, written, video) to maximize the likelihood of retention.¹ It is also important to offer an opportunity for patients to ask questions about this information after they have received it (for example, by phoning the patients prior to their procedure).
 

Preoperative strategies

Intraoperative strategies

Consider in-and-out catheterization rather than placement of an indwelling catheter for anticipated short cases without complex bladder dissection.⁵ Minimize blood loss and maximally evacuate blood and clots with suction because hemoperitoneum can induce nausea and pain.

Pain from retained gas under the diaphragm can be reduced by bathing the diaphragms with 400 cc of dilute local anesthetic made by mixing 50 mL of 0.5% bupivacaine in 1000 mL normal saline prior to removal of pneumoperitoneum and while still in Trendelenburg. Ensure there is minimal retained intraperitoneal CO₂ at the completion of the surgery by asking the anesthesiologists to perform positive pressure ventilations prior to fascial closure. Consider injecting port sites (including the peritoneal and fascial layers) with a mixture of immediate and long-acting local anesthetics. Request that the anesthesia staff administer intraoperative doses of IV ketorolac, acetaminophen, and tramadol (in preference to opioids) and an aggressive perioperative cocktail of antiemetics.

Management in the recovery room

Surgeons should ensure that recovery room staff are well versed in the pathway for patients who are selected for SDD to ensure proactive implementation of analgesic and antiemetic regimens and to fast-track the various tasks and education required for discharge.⁵

Patients should be started on their home postoperative medication regimen in the recovery room, including an anti-inflammatory such as diclofenac, sublingual tramadol (in preference to an opioid, such as hydrocodone), docusate, and sennosides. IV opioids should be avoided because they can result in somnolence and nausea.

If placed intraoperatively, the Foley catheter should be removed early to allow adequate time to void. Backfilling the bladder prior to removal can hasten the urge to void and help objectively document completeness of evacuation. All patients should be seen by the anesthesiologist and/or surgeon prior to discharge.

For patients who are discharged same day, a follow-up phone call on postoperative day 1 is valuable to ensure that they have continued their successful postoperative transition to the home and to intervene early if there are concerns for patient satisfaction.

Dr. Rossi is an assistant professor in the division of gynecologic oncology at the University of North Carolina at Chapel Hill.

References

1. Fountain CR et al. Promoting same-day discharge for gynecologic oncology patients in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):932-9.

2. Rivard C et al. Factors influencing same-day hospital discharge and risk factors for readmission after robotic surgery in the gynecologic oncology patient population. J Minim Invasive Gynecol. 2015 Feb;22(2):219-26.

3. Lee SJ et al. The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications. Gynecol Oncol. 2014 Jun;133(3):552-5.

4. Elia N et al. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005 Dec;103(6):1296-304.

5. Donnez O et al. Low pain score after total laparoscopic hysterectomy and same-day discharge within less than 5 hours: Results of a prospective observational study. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1293-9.

There is an increased focus on reducing the costs of health care delivery, and one major driver of surgical cost is length of hospitalization. A minimally invasive surgical approach to hysterectomy is a strategy that significantly enhances recovery and shortens hospital stay, although many patients who can safely be considered for same-day discharge (SDD), including many with cancer, are still admitted to the hospital overnight. Much has been published on the predictors and pathways for successful same-day discharge after minimally invasive hysterectomy, and in this column we will review how to best predict who is a good candidate for SDD and how to optimize the success of this approach with respect to safety and patient satisfaction.

What are the benefits to SDD?

Certainly, decreased hospitalization costs are an attractive feature of SDD following hysterectomy, although surgeons should also be mindful that patient-centered outcomes, such as pain control, managing nausea, and patient satisfaction, also are considered with equal emphasis. Several studies have shown that, in appropriate candidates and when proactive pathways are used, patient satisfaction is preserved with SDD following hysterectomy.¹

Choosing patient candidates

Same day discharge is most successfully accomplished in patients of good general baseline health.² Diabetic patients, particularly those on insulin, are generally not good candidates for SDD because it is important to monitor and intervene in blood glucose changes that are influenced by a nothing-by-mouth status and surgical stress. We recommend observing patients overnight with a history of pulmonary disease who may have transient increased postoperative O₂ needs. Similarly, patients with significant cardiac disease (including heart failure and coronary disease) may benefit from prolonged overnight observation.

Particular caution should be paid to patients with obstructive sleep apnea, which may be occult but anticipated in patients with very high body mass indexes (greater than 40 kg/m²). General anesthetic drugs, the trauma of intubation, and opioids all couple with the underlying airway compromise such that these patients are at risk for postoperative apnea, which, in severe cases, can result in anoxia and death. These patients should be considered for continuous pulse-ox monitoring for at least 12-24 hours postoperatively and are not good candidates for same-day discharge.

Patients who have baseline anticoagulation that has been stopped or bridged preoperatively should have prolonged observation with recheck of their postoperative hemoglobin prior to discharge.

Patients who live alone or are very elderly with baseline frailty are poor candidates for SDD and may benefit from nursing observation overnight while they metabolize their anesthesia. Patients who have chronic opioid dependency present a greater challenge to control postoperative pain; these patients are generally less good candidates for SDD.

Studies have shown that the indication for the procedure (for example, cancer with staging, fibroids, endometriosis) is less critical in determining who is a good candidate for SDD.³ However, successful SDD rates are highest in more straightforward cases with few or no prior surgeries, small uteri (less than 14 weeks), a surgical duration of less than 3 hours, and a surgical start time before 2 p.m. Longer, more complex cases are typically associated with more blood loss, higher risk for occult complications, and more time under anesthesia (and in Trendelenburg), which can exacerbate airway edema. In preparation for such cases, it might be wise to prepare patients for the possibility that they may not be good candidates for discharge on the same day. In general, most SDD pathways exclude patients with very high BMI (greater than 50 kg/m²) because of concern for airway patency and because these cases may be more complex with higher underlying risk. In addition, many of these patients have diabetes and require perioperative metabolic interventions.

Patient preparation

A key component to successful SDD is setting patient expectations. Patients should be informed at their preoperative visit that, unless there is an unexpected occurrence or response to the surgery, they will be discharged to home the same day. This allows them to prepare their home (including transportation needs) in advance. They should be provided with information about what to expect that first night after surgery (including potential residual drowsiness or nausea from anesthesia and immediate postoperative pain).

On the day of surgery, under the influence of anesthesia and pain medication, patients will have difficulty retaining complex discharge instructions. The preoperative visit is critically important because it’s the best time to provide them with this information, including postoperative activity limitations, wound and dressing care, and follow-up instructions. This is also the best time to provide prescriptions for postoperative pain, nausea, and constipation prophylaxis with detailed instructions about best use. Patients should be encouraged to fill these prescriptions preoperatively so that they have these medications on hand on the evening of their discharge.

Many programs utilize a combination of educational strategies (in person, written, video) to maximize the likelihood of retention.¹ It is also important to offer an opportunity for patients to ask questions about this information after they have received it (for example, by phoning the patients prior to their procedure).
 

Preoperative strategies

Intraoperative strategies

Consider in-and-out catheterization rather than placement of an indwelling catheter for anticipated short cases without complex bladder dissection.⁵ Minimize blood loss and maximally evacuate blood and clots with suction because hemoperitoneum can induce nausea and pain.

Pain from retained gas under the diaphragm can be reduced by bathing the diaphragms with 400 cc of dilute local anesthetic made by mixing 50 mL of 0.5% bupivacaine in 1000 mL normal saline prior to removal of pneumoperitoneum and while still in Trendelenburg. Ensure there is minimal retained intraperitoneal CO₂ at the completion of the surgery by asking the anesthesiologists to perform positive pressure ventilations prior to fascial closure. Consider injecting port sites (including the peritoneal and fascial layers) with a mixture of immediate and long-acting local anesthetics. Request that the anesthesia staff administer intraoperative doses of IV ketorolac, acetaminophen, and tramadol (in preference to opioids) and an aggressive perioperative cocktail of antiemetics.

Management in the recovery room

Surgeons should ensure that recovery room staff are well versed in the pathway for patients who are selected for SDD to ensure proactive implementation of analgesic and antiemetic regimens and to fast-track the various tasks and education required for discharge.⁵

Patients should be started on their home postoperative medication regimen in the recovery room, including an anti-inflammatory such as diclofenac, sublingual tramadol (in preference to an opioid, such as hydrocodone), docusate, and sennosides. IV opioids should be avoided because they can result in somnolence and nausea.

If placed intraoperatively, the Foley catheter should be removed early to allow adequate time to void. Backfilling the bladder prior to removal can hasten the urge to void and help objectively document completeness of evacuation. All patients should be seen by the anesthesiologist and/or surgeon prior to discharge.

For patients who are discharged same day, a follow-up phone call on postoperative day 1 is valuable to ensure that they have continued their successful postoperative transition to the home and to intervene early if there are concerns for patient satisfaction.

Dr. Rossi is an assistant professor in the division of gynecologic oncology at the University of North Carolina at Chapel Hill.

References

1. Fountain CR et al. Promoting same-day discharge for gynecologic oncology patients in minimally invasive hysterectomy. J Minim Invasive Gynecol. 2017 Sep-Oct;24(6):932-9.

2. Rivard C et al. Factors influencing same-day hospital discharge and risk factors for readmission after robotic surgery in the gynecologic oncology patient population. J Minim Invasive Gynecol. 2015 Feb;22(2):219-26.

3. Lee SJ et al. The feasibility and safety of same-day discharge after robotic-assisted hysterectomy alone or with other procedures for benign and malignant indications. Gynecol Oncol. 2014 Jun;133(3):552-5.

4. Elia N et al. Does multimodal analgesia with acetaminophen, nonsteroidal antiinflammatory drugs, or selective cyclooxygenase-2 inhibitors and patient-controlled analgesia morphine offer advantages over morphine alone? Meta-analyses of randomized trials. Anesthesiology. 2005 Dec;103(6):1296-304.

5. Donnez O et al. Low pain score after total laparoscopic hysterectomy and same-day discharge within less than 5 hours: Results of a prospective observational study. J Minim Invasive Gynecol. 2015 Nov-Dec;22(7):1293-9.

Important advances in neuroscience and clinical psychiatry have been achieved in recent years, but there are significant gaps in knowledge and much that we don’t understand about the brain and behavior. Further advances depend on cultivating and supporting a new generation of dedicated basic science and clinical investigators. While there is a compelling need to attract, recruit, and encourage talented individuals to pursue scholarly interests, competing life and career demands often prove daunting.

• Participants will learn the steps necessary to prepare a scientific manuscript for publication.
• Participants will review comments by expert referees and learn to incorporate and respond to the peer review process.
• Participants will review the evidence related to the diagnosis and treatment of tardive dyskinesia.
• Participants will be introduced to the spectrum of educational and networking opportunities at the Institute for Psychiatric Services conference.

In the past, this program was very popular and gained national recognition among psychiatric trainees. Numerous submitted papers were accepted for publication in peer-reviewed journals after the competition was completed.

Instructions for manuscript preparation are:

• First author must be a student, resident, or fellow.
• Papers should address specific issues related to the theme of tardive dyskinesia and be no longer than 15 double-spaced typed pages in length (excluding references and illustrations).
• Literature reviews, case reports, or studies that are original and newly developed or recently published are acceptable.
• Reviews and feedback will be provided by a panel of academic psychiatrists.
• Papers will be judged on relevance to tardive dyskinesia, originality, scholarship, scientific rigor, valid methodology, clinical significance, and organization.

To participate, papers and curriculum vitae of the first author must be submitted by July 1, 2018, to Dianne Daugherty by email at [email protected]. Winners will be announced by Aug. 10, 2018. For additional information, write to [email protected] or visit www.mhaus.org/nmsis/about-us/what-is-nmsis.
 

Dr. Caroff, professor of psychiatry, Corporal Michael J. Crescenz VA Medical Center and at the University of Pennsylvania, both in Philadelphia, is director of the NMSIS. He served as consultant to Neurocrine Biosciences and Teva Pharmaceutical Industries, and receives research grant funding from Neurocrine Biosciences.

Important advances in neuroscience and clinical psychiatry have been achieved in recent years, but there are significant gaps in knowledge and much that we don’t understand about the brain and behavior. Further advances depend on cultivating and supporting a new generation of dedicated basic science and clinical investigators. While there is a compelling need to attract, recruit, and encourage talented individuals to pursue scholarly interests, competing life and career demands often prove daunting.

• Participants will learn the steps necessary to prepare a scientific manuscript for publication.
• Participants will review comments by expert referees and learn to incorporate and respond to the peer review process.
• Participants will review the evidence related to the diagnosis and treatment of tardive dyskinesia.
• Participants will be introduced to the spectrum of educational and networking opportunities at the Institute for Psychiatric Services conference.

In the past, this program was very popular and gained national recognition among psychiatric trainees. Numerous submitted papers were accepted for publication in peer-reviewed journals after the competition was completed.

Instructions for manuscript preparation are:

• First author must be a student, resident, or fellow.
• Papers should address specific issues related to the theme of tardive dyskinesia and be no longer than 15 double-spaced typed pages in length (excluding references and illustrations).
• Literature reviews, case reports, or studies that are original and newly developed or recently published are acceptable.
• Reviews and feedback will be provided by a panel of academic psychiatrists.
• Papers will be judged on relevance to tardive dyskinesia, originality, scholarship, scientific rigor, valid methodology, clinical significance, and organization.

To participate, papers and curriculum vitae of the first author must be submitted by July 1, 2018, to Dianne Daugherty by email at [email protected]. Winners will be announced by Aug. 10, 2018. For additional information, write to [email protected] or visit www.mhaus.org/nmsis/about-us/what-is-nmsis.
 

Dr. Caroff, professor of psychiatry, Corporal Michael J. Crescenz VA Medical Center and at the University of Pennsylvania, both in Philadelphia, is director of the NMSIS. He served as consultant to Neurocrine Biosciences and Teva Pharmaceutical Industries, and receives research grant funding from Neurocrine Biosciences.

Important advances in neuroscience and clinical psychiatry have been achieved in recent years, but there are significant gaps in knowledge and much that we don’t understand about the brain and behavior. Further advances depend on cultivating and supporting a new generation of dedicated basic science and clinical investigators. While there is a compelling need to attract, recruit, and encourage talented individuals to pursue scholarly interests, competing life and career demands often prove daunting.

• Participants will learn the steps necessary to prepare a scientific manuscript for publication.
• Participants will review comments by expert referees and learn to incorporate and respond to the peer review process.
• Participants will review the evidence related to the diagnosis and treatment of tardive dyskinesia.
• Participants will be introduced to the spectrum of educational and networking opportunities at the Institute for Psychiatric Services conference.

In the past, this program was very popular and gained national recognition among psychiatric trainees. Numerous submitted papers were accepted for publication in peer-reviewed journals after the competition was completed.

Instructions for manuscript preparation are:

• First author must be a student, resident, or fellow.
• Papers should address specific issues related to the theme of tardive dyskinesia and be no longer than 15 double-spaced typed pages in length (excluding references and illustrations).
• Literature reviews, case reports, or studies that are original and newly developed or recently published are acceptable.
• Reviews and feedback will be provided by a panel of academic psychiatrists.
• Papers will be judged on relevance to tardive dyskinesia, originality, scholarship, scientific rigor, valid methodology, clinical significance, and organization.

To participate, papers and curriculum vitae of the first author must be submitted by July 1, 2018, to Dianne Daugherty by email at [email protected]. Winners will be announced by Aug. 10, 2018. For additional information, write to [email protected] or visit www.mhaus.org/nmsis/about-us/what-is-nmsis.
 

Dr. Caroff, professor of psychiatry, Corporal Michael J. Crescenz VA Medical Center and at the University of Pennsylvania, both in Philadelphia, is director of the NMSIS. He served as consultant to Neurocrine Biosciences and Teva Pharmaceutical Industries, and receives research grant funding from Neurocrine Biosciences.

Over the last few years, I have spoken to many people about their experiences with involuntary psychiatric hospitalizations. While the stories I’ve heard are anecdotes, often from people who have reached out to me, and not randomized, controlled studies, I’ve taken the liberty of coming to a few conclusions. First, involuntary hospitalizations help people. Most people say that they left the hospital with fewer symptoms than they had when they entered. Second, many of those people, helped though they may have been, are angry about the treatment they received. An unknown percentage feel traumatized by their psychiatric treatment, and years later they dwell on a perception of injustice and injury.

It’s perplexing that this negative residue remains given that involuntary psychiatric care often helps people to escape from the torment of psychosis or from soul-crushing depressions. While many feel it should be easier to involuntarily treat psychiatric disorders, there are no groups of patients asking for easier access to involuntary care. One group, Mad in America – formed by journalist Robert Whitaker – takes the position that psychiatric medications don’t just harm people, but that psychotropic medications actually cause psychiatric disorders in people who would have fared better without them. It now offers CME activities through its conferences and website!

I wanted to know what psychiatrists might learn from his experiences with involuntary care. Weinstein hesitated. “It wasn’t the best experience, and I felt there had to be a better way, but I know everyone was trying to help me, and I want my overall message to be one of hope. I don’t want to complain, because I’ve ended up in a much better place, I’m back at work, enjoying my family, and I feel joy now.”

For psychiatrists, this is the best outcome from a story such as Dr. Weinstein’s. He’s much better, in a scenario where he could have just as easily have died, and he wasn’t traumatized by his care. However, he avoided returning to inpatient care at a precarious time, and he’s left asking if there weren’t a gentler way this could have transpired. These questions are easier to look at from the perspective of a Monday morning quarterback than they are to look at from the perspective of a treatment team dealing with a very sick and combative patient. Still, I hope we all continue to question patients about their experiences and ask if there might be better ways.
 

Dr. Miller, who practices in Baltimore, is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016).

Over the last few years, I have spoken to many people about their experiences with involuntary psychiatric hospitalizations. While the stories I’ve heard are anecdotes, often from people who have reached out to me, and not randomized, controlled studies, I’ve taken the liberty of coming to a few conclusions. First, involuntary hospitalizations help people. Most people say that they left the hospital with fewer symptoms than they had when they entered. Second, many of those people, helped though they may have been, are angry about the treatment they received. An unknown percentage feel traumatized by their psychiatric treatment, and years later they dwell on a perception of injustice and injury.

It’s perplexing that this negative residue remains given that involuntary psychiatric care often helps people to escape from the torment of psychosis or from soul-crushing depressions. While many feel it should be easier to involuntarily treat psychiatric disorders, there are no groups of patients asking for easier access to involuntary care. One group, Mad in America – formed by journalist Robert Whitaker – takes the position that psychiatric medications don’t just harm people, but that psychotropic medications actually cause psychiatric disorders in people who would have fared better without them. It now offers CME activities through its conferences and website!

I wanted to know what psychiatrists might learn from his experiences with involuntary care. Weinstein hesitated. “It wasn’t the best experience, and I felt there had to be a better way, but I know everyone was trying to help me, and I want my overall message to be one of hope. I don’t want to complain, because I’ve ended up in a much better place, I’m back at work, enjoying my family, and I feel joy now.”

For psychiatrists, this is the best outcome from a story such as Dr. Weinstein’s. He’s much better, in a scenario where he could have just as easily have died, and he wasn’t traumatized by his care. However, he avoided returning to inpatient care at a precarious time, and he’s left asking if there weren’t a gentler way this could have transpired. These questions are easier to look at from the perspective of a Monday morning quarterback than they are to look at from the perspective of a treatment team dealing with a very sick and combative patient. Still, I hope we all continue to question patients about their experiences and ask if there might be better ways.
 

Dr. Miller, who practices in Baltimore, is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016).

Over the last few years, I have spoken to many people about their experiences with involuntary psychiatric hospitalizations. While the stories I’ve heard are anecdotes, often from people who have reached out to me, and not randomized, controlled studies, I’ve taken the liberty of coming to a few conclusions. First, involuntary hospitalizations help people. Most people say that they left the hospital with fewer symptoms than they had when they entered. Second, many of those people, helped though they may have been, are angry about the treatment they received. An unknown percentage feel traumatized by their psychiatric treatment, and years later they dwell on a perception of injustice and injury.

It’s perplexing that this negative residue remains given that involuntary psychiatric care often helps people to escape from the torment of psychosis or from soul-crushing depressions. While many feel it should be easier to involuntarily treat psychiatric disorders, there are no groups of patients asking for easier access to involuntary care. One group, Mad in America – formed by journalist Robert Whitaker – takes the position that psychiatric medications don’t just harm people, but that psychotropic medications actually cause psychiatric disorders in people who would have fared better without them. It now offers CME activities through its conferences and website!

I wanted to know what psychiatrists might learn from his experiences with involuntary care. Weinstein hesitated. “It wasn’t the best experience, and I felt there had to be a better way, but I know everyone was trying to help me, and I want my overall message to be one of hope. I don’t want to complain, because I’ve ended up in a much better place, I’m back at work, enjoying my family, and I feel joy now.”

For psychiatrists, this is the best outcome from a story such as Dr. Weinstein’s. He’s much better, in a scenario where he could have just as easily have died, and he wasn’t traumatized by his care. However, he avoided returning to inpatient care at a precarious time, and he’s left asking if there weren’t a gentler way this could have transpired. These questions are easier to look at from the perspective of a Monday morning quarterback than they are to look at from the perspective of a treatment team dealing with a very sick and combative patient. Still, I hope we all continue to question patients about their experiences and ask if there might be better ways.
 

Dr. Miller, who practices in Baltimore, is coauthor with Annette Hanson, MD, of “Committed: The Battle Over Involuntary Care” (Baltimore: Johns Hopkins University Press, 2016).