S a n M at e o C o u n t y
September 2015
Physician
IN S ID E
S A N M AT E O C O U N T Y M E D I C A L A S S O C I AT I O N
Volume 4 Issue 8
The courage to have empathy and forgive
Childhood obesity: The link to drinks
Adolescent risk-taking in the age of social media
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S a n M at e o C o u n t y
Physician Editorial Committee Russ Granich, MD, Chair Uli Chettipally, MD Sharon Clark, MD Edward Morhauser, MD Gurpreet Padam, MD Sue U. Malone, Executive Director Shannon Goecke, Managing Editor
SMCMA Leadership Michael Norris, MD, President; Russ Granich, MD, President-Elect; Alexander Ding, MD, SecretaryTreasurer; Vincent Mason, MD, Immediate Past President Toby Frescholtz, MD; Alex Lakowsky, MD; Richard Moore, MD; Michael O’Holleran, MD; Joshua Parker, MD; Suzanne Pertsch, MD; Xiushui (Mike) Ren, MD; Sara Whitehead, MD; Douglas Zuckermann, MD; Scott A. Morrow, MD, Health Officer, County of San Mateo; Dirk Baumann, MD, AMA Alternate Delegate
Editorial/Advertising Inquiries San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.
September 2015 - Volume 4, Issue 8 Columns President’s Message: Star Wars and reconstructive surgery..................... 4 Michael Norris, MD
Executive Report: Vaccination opponents seek to recall Richard Pan..... 5 Sue U. Malone
Feature Articles Teaching teenagers empathy and forgiveness. . ...................................... 6 Adekemi Oguntala, MD
Childhood obesity: The link to drinks. . .................................................... 8 Rodrick D. McKinlay, MD
Adolescent risk-taking in the age of social media................................ 10 Gloria Moskowitz- Sweet, PPSC, LCSW, and Erica Pelavin, LCSW, PhD
Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised. For more information, contact the managing editor at (650) 312-1663 or sgoecke@smcma.org. Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc. © 2015 San Mateo County Medical Association
Of Interest Membership updates, classified ads, index of advertisers. . ................14
President’s Message
Star Wars and reconstructive surgery
Michael Norris, MD President
Another approach to these patients, many of whom are armed service members from the Iraq/Afghanistan wars, is via hard or limb transplantation. Patient selection and counseling are done very carefully, as transplantation carries the lifetime need for immunosuppression and close follow-up.
In September, I visited Seattle for the annual meeting of the American Society for Surgery of the Hand. Whenever I’m in Seattle, I always try to go to the Experience Music Project, a museum devoted to rock music housed in an iconic building by architect Frank Gehry. Founded in 2000 by Microsoft co-founder Paul Allen, it has a wealth of exhibits, interactive activity stations, and various educational resources. If you’re in Seattle, I highly recommend you check it out; it’s right next to the Space Needle. The featured exhibit at the time of my visit was devoted to Star Wars, with dozens of costumes and other items from the six Star Wars movies. I took only a passing interest, thinking I knew everything that I needed to know about Star Wars. Was I mistaken… Back at the meeting, one panel was on the rehabilitation and reconstruction of upper extremity amputations. The first speaker began his talk by showing a slide from Star Wars. If you recall, at the end of The Empire Strikes Back, Darth Vader amputated Luke Skywalker’s hand with his light saber. Luke then received a new bioelectric hand and returned to business as usual. We are now entering an era where this type of reconstruction is being pursued on two fronts. There are new technology and surgical approaches utilizing targeted muscle reinnervation, allowing the use of prostheses that can simulate fine finger dexterity. One patient was shown using chopsticks! Though not a light saber, still very impressive. Another approach to these patients, many of whom are Armed Service members from the Iraq/ Afghanistan wars, is via hand or limb transplantation. Patient selection and counseling are done very carefully, as transplantation carries the lifetime need for immunosuppression and close follow-up. We also heard from the lead surgeon of the team that recently performed bilateral hand transplants in a four-year-old child. Though limited in numbers worldwide, allograft limb transplantation is a reality. The two groups of surgeons, prostheses and transplantation, showed results that were not dreamed of a few short years ago. We are certainly entering the realm of science fiction with modern medical techniques and innovations. These procedures call upon the skills of large teams, with the microsurgical repair of tiny nerves and vessels an essential component. We give thanks and recognition to the late Dr. Harry Buncke, the San Mateo plastic surgeon who almost single-handedly developed the field of microsurgery, making his own needles and sutures and experimenting on tissue transfers and limb replants, in his garage, before a local hospital gave him lab space. I guess this shouldn’t really come as a surprise, since Hewlett-Packard, Apple, and Microsoft all started out in garages, too. ■
4 SAN MATEO COUNTY PHYSICIAN | SEPTEMBER 2015
Executive Report
Vaccination opponents seek to recall Richard Pan When pediatrician Richard Pan, MD, a democrat representing District 6 in California’s State Senate, was in medical school, he and his classmates studied photos of measles. “The professors told us we’d likely never see the disease in person,” said Pan. But he did. In 1991, a measles outbreak in Philadelphia sickened 900 people. Nine children died. Pan was a student at the University of Pittsburgh School of Medicine at the time. More recently, in early 2015, the U.S. experienced a large, multi-state measles outbreak linked to Disneyland, and a traveler who became infected overseas with measles and visited the amusement park while infectious. The outbreak sickened 147 people in the U.S., including 131 in California.
Sue U. Malone Executive Director
In the intervening years, Dr. Pan relocated to Sacramento and joined the faculty of UC Davis, and went on to direct the school’s pediatric residency program. Pan decided to run for public office in 2010 after becoming frustrated with the budget gridlock that had become customary in Sacramento and seeing first-hand how it impacted patients’ access to quality care. He served for four years and chaired the Assembly’s Health Committee.
The passing of the torch...
Pan was next elected to the California State Senate, in late 2014, not long before the measles outbreak at Disneyland. Just weeks later, he introduced Senate Bill 277, co-authored with Ben Allen (D-Santa Monica), the son of a polio survivor. SB 277 requires almost all California schoolchildren to be fully vaccinated in order to attend public or private school, regardless of their parents’ personal or religious beliefs.
From its inception, the bill was met with opposition and controversy. Its authors and supporters were harassed and bullied by some opponents of the legislation, but that only strengthened their resolve. Governor Brown signed SB 277 on June 30, 2015, making California one of only three states (the others being Mississippi and West Virginia) that permit only medical exemptions as legitimate reasons to sidestep vaccinations. Before the ink from Governor Brown’s pen was dry, former Republican Assemblymember Tim Donnelly filed a referendum to overturn SB 277. The organizers have until the end of the year to collect signatures from at least 365,880 registered voters for the 2016 ballot. Opponents of SB 277 are also attempting to recall Pan, Allen, and others who supported the legislation. An effort to recall Pan was launched on May 28, 2015 and has until the end of the year to collect at least 35,926 verified signatures to force a recall. Physicians throughout the state are stepping up to support Richard Pan. If you wish to make a financial contribution to the campaign working to keep him in office, visit www.keepdrpan.com. ■
Governor Brown signed SB 277 on June 30, 2015, making California one of only three states (the others being Mississippi and West Virginia) that permit only medical exemptions as legitimate reasons to sidestep vaccinations.
SEPTEMBER 2015 | SAN MATEO COUNTY PHYSICIAN 5
TEACHING TEENAGERS EMPATHY AND FORGIVENESS
H
urt people hurt other people. People who are hurting emotionally want other people to feel their pain. When people are treated poorly, they instinctively think to blame someone, to get someone back. They want the person, establishment or thing they can blame to relieve their pain. Yet, when this blame is doled out, it rarely provides relief. by Adekemi Oguntala, MD In the end, that hurt resolves when, and only when, they can let go of the pain on their own accord. It is true there are times the contrition of another person or entity can make it easier to let this pain go, but still in the end, it is a decision that someone has to make for themselves. Each person comes to this moment in their own way and in their own time, but when they do they understand immediately that this is a gift they have been given and a burden that has been lifted. When Nelson Mandela was released from prison after being incarcerated for 27 years, he said he knew that if he did not leave his bitterness and hatred behind that he would still be in prison. This is what the inability to forgive does. The grudge, anger, hatred or feeling that a person is owed creates a pain that keeps them in an emotional prison. Hurt people find it difficult to forgive, to pardon a perceived wrongdoing. As an adolescent medicine physician, I have the opportunity to speak to teens who have perpetuated gossip or bullying, both real and virtual, and they often cite the injustices done to them to justify their behavior toward others. They think forgiveness is equivalent to saying that what was done to them was acceptable. It seems like a sign of defeat rather than a decision coming from courage and emotional strength.
6 SAN MATEO COUNTY PHYSICIAN | SEPTEMBER 2015
Why? Because emotional vulnerability has been left out of conversations with our teens, our community and our nation. We have asked them to do college work in high school, but we have not asked them to take responsibility when they are wrong. We have asked them to complete resumes that reflect unreasonable intelligence, but we have not asked them to exhibit unreasonable compassion toward themselves or others. In essence, we have defined their worth by their intellectual capacity and left no room for them to develop their emotional vulnerability. We have forgotten to define them by their goodness. This has created teens who define themselves by their academic prowess instead of their humanity, so that the thought of being imperfect, being human, creates fear and an inability to see the humanity in others. It prevents empathy. When teens can see and accept their own imperfections, they can accept the imperfections of others. This empathy creates an opportunity to forgive. The myth is that forgiveness means that the original wrongdoing was acceptable. Really, forgiveness is something one does for oneself to loosen the grip of anger and hurt before it can become a mental and physical illness. The hurt is discussed honestly, instead of repressed and numbed with anger and hostility, depression and self-destructive behavior. We frequently see the results of this numbing in the teen medicine clinic.
Hurt people hurt other people. People who are unable to forgive others find it difficult to forgive themselves. One may try to suppress the hurt by burying it, but it lingers like a stone in the shoe. This hurt makes it difficult for parents to show empathy and compassion to their teens when they do something “unforgiveable,” e.g., earn poor grades, get pregnant, or experiment with drugs or alcohol. However, when parents can understand that they are worthy of forgiveness, when they understand that forgiveness is a gift, they want to give that gift to their teens. I always ask parents to consider that when their teen has made a poor choice, the teen’s awareness of having disappointed them can create feelings of shame so overwhelming that the teen will not ask for help. Teens often see no way out of this shame and have died as a result of this heavy burden. How priceless is the gift to say, “You are forgiven and I still love you. We will get through this—together.” When teens do not think they will be forgiven, it is like withholding love from them. When they feel this judgment, they feel unlovable, and unworthy. This feeling disconnects them from others. To forget this pain, teens build an armor of distrust and it sounds like “I don’t care.” In this emotional state, they do not care who else hurts.
UPstanders instead of bystanders when they see someone hurting. Edmund Burke, the political philosopher, said that evil is allowed to persist when good people do nothing. People who feel loved love themselves enough to be able to love others. They can garner the courage to speak out for others. They become the good people who do something. This is the power of forgiveness and empathy.
When Nelson Mandela was released from prison after being incarcerated for 27 years, he said he knew that if he did not leave his bitterness and hatred behind that he would still be in prison.
We are insulted by someone else’s remarks because we fear there is an element of truth. However, when we understand that the person making the comment is acting out of hurt, we can quickly see how the situation calls for compassion and not anger. This provides the strength to forgive and walk away. But we are imperfect and forget to do this. We need to remind ourselves to ignore our first impulse to blame and go to our second impulse—to be, as Gandhi said, the change we wish to see in the world. When teens can see and hear their parents’ empathy, they learn to empathize and think before they act at school, online, or on a date. In order to stop the hurt, we must as the authority figures in our teens’ lives not wield our forgiveness as something our teen must beg for, but something given unconditionally and with love. It does not always mean that we will forget the hurt, but we will not use that hurt to make our teen feel hurt. This gift is priceless. It creates a teen who has a big enough heart not only to empathize with others, but stick up for others. They can become
The courage that it takes a parent to know that he or she is worthy of forgiveness is the same courage that allows one’s teen to forgive the actions of others even when those actions would typically be judged as deplorable. Because forgiveness is really about the teen’s physical and mental health, they can never walk away feeling weak as a result. Instead, they walk away knowing they have contributed to a culture where forgiveness is valued more than retaliation, and empathy is valued more than divisiveness and hate. They can walk away knowing they have given others the courage to do the same. They take the power away from others to demean, pigeonhole and judge them. Ultimately, they walk away knowing they are good and lovable regardless of their mistakes, on the road to becoming courageous adults who can change the world. ■
About the author Adekemi Oguntala, MD, or “Dr. O” as she’s called by many of her patients, is an adolescent medicine physician and the voice of theteendoc.com, with resources and programs to help teenagers and their parents navigate adolescence. Her publications include Small Changes, Big Impact (With Your Teen) and Are You Serious? It’s Just Sex!: The 17 Most Frequently Asked Questions By Parents of Teens.
SEPTEMBER 2015 | SAN MATEO COUNTY PHYSICIAN 7
CHILDHOOD OBESITY: THE LINK TO DRINKS
C
hildhood obesity rates have doubled throughout the past 30 years in the United States for children ages 2-5 and 12-19, and tripled in the age group of 6-11. Obesity for children is defined as a body mass index (BMI) at or above the 95th percentile for similar age and gender youths.1 by Rodrick D. McKinlay, MD Social and environmental pressures Many social and environmental pressures lead to greater obesity in children. Chief among these influences is the wide variety and availability of sugar-sweetened drinks that contain little to no nutritional value. These beverages include: •
Soft drinks
•
Sports drinks
•
Fruit drinks
•
Flavored teas and coffees
•
Energy drinks
Throughout the past 10 to 15 years, these drinks have exploded on to the consumer scene, flooding grocery stores, gas stations, convenience stores and vending machines. Americans have doubled their consumption of soda in the last 25 years, a trend that closely follows the obesity epidemic. The average American drinks 1.6 cans of soda a day, more than 500 cans a year. Soda drinking is particularly rampant among teenagers. Data indicates that soft drinks account for 13 percent of a teenager’s caloric intake—by far the largest source of calories in his or her diet. For decades, milk was the most common beverage consumed by children, but by
8 SAN MATEO COUNTY PHYSICIAN | SEPTEMBER 2015
the mid-1990s, boys and girls were drinking twice as much soda as milk. One recent, independent peer-reviewed study from Harvard demonstrated a strong link between consumption of sugar-sweetened beverages and childhood obesity.2 Although some studies conflict regarding the causality between sugar-sweetened beverages and obesity, a number of research studies confirm the Harvard group’s findings that increased soft drink and sugar-laden beverage consumption is a risk factor for obesity.3 Not only do sugar-sweetened drinks likely lead to obesity, they are also associated with tooth decay and weakening bones.
Energy drink emergence In the past decade, energy drinks have exploded into the marketplace. In 2006 alone, 500 new energy drinks were launched. Energy drinks, which typically contain large amounts of sugar and caffeine, are equally if not more dangerous to children. Although the target market for energy drinks is young adults aged 18-35, teenagers are consuming significant quantities of these beverages.
Caffeine by the can The amounts of caffeine found in such drinks as Red Bull or Rock Star are about 10 grams per ounce. With
that in mind, take a look at the amount of caffeine found in these beverages: •
Red Bull (8.3 ounce can) = 83 grams
•
Rock Star (16 ounce can) = 160 grams
•
Coca-Cola Classic (12 ounce can) = 34.5 grams
•
Pepsi-Cola (12 ounce can) = 38 grams
•
Coffee (8 ounce cup) = 57 grams
Most experts recommend that children consume well under 100 grams of caffeine per day.
Effects of caffeine on children Pharmacologic effects of caffeine are notable in children, most commonly seen as hyperactivity, sleep disturbances and restlessness. Drinking large amounts of caffeine can also be associated with high blood pressure and frequent headaches. Researchers have reported that a new practice among collegeage students is the simultaneous consumption of energy drinks and alcohol, which allows greater consumption of alcohol since
Soft drinks account for 13 percent of a
machines that sell soft drinks and energy drinks in favor of bottled water. Moderation in guiding children, of course, is appropriate. Children who are constantly deprived of treats are more likely to binge eat or drink. Also, parental modeling is important. Studies suggest that children who are raised by parents who exert excessive dietary restraint may be more likely to become obese.5 Children possess the ability to internally regulate their caloric intake. If they see their parents struggle with alternating disinhibited eating (abandoning the effort to control food or drink intake) and restrained eating (conscious decision to restrict intake to control weight), they may pattern their own eating and drinking behavior after their parents instead of allowing their internal energy regulation to guide them. This in turn seems to lead to greater obesity in children.
Conclusion Parents should adopt healthy eating and drinking patterns, limiting consumption of soft drinks and other sugar-sweetened drinks, and to do so without obsession. Helping children develop a love for the refreshing taste of water or a cold glass of milk will pay immediate health rewards for children as well as dividends for their future health and weight control. ■
teenager’s caloric intake—by far the large
About the Author Rodrick D. McKinlay, MD, is a bariatric surgeon with Rocky Mountain Associated Physicians (RMAP) in Salt Lake City.This article was originally published by the Obesity Action Coalition,a national non-profit organization dedicated to improving the lives of individuals affected by the disease of obesity.
source of calories in his or her diet. alertness is perpetuated by the energy drink.4 In addition, the sugar content of energy drinks is comparable or higher than most soft drinks. For example, an 8 ounce Red Bull contains 27 grams of sugar and a 16 ounce Rock Star has 60 grams of sugar, while the typical non-diet soft drink contains 40-45 grams of sugar.
How to combat the high-calorie beverage craze So what can be done to limit the amount of nutritionally-poor liquid calories that children and adolescents are consuming? On an individual-basis, the best approach is simply to replace soda and sports drinks with water or low-fat milk in children’s diets. Water is the best hydrator available. Low-fat milk not only hydrates, but delivers calcium, protein and vitamin D.
References 1. 2.
3. 4. 5.
Childhood Obesity in the United States: Facts and Figures, Fact Sheet 2004, Institute of Medicine. Ludwig et al, Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001; Feb 17; 357 (9255):505-8. Wolff et al, Medscape J Med 2008; 10(8):189. Malinauskas et al, Nutrition Journal 2007; 6:35. Hood et al, International Journal of Obesity 2000; 10:1319-1325.
Children should be monitored at home with their choice of liquids. A glass of 100 percent fruit juice per day is beneficial, but excessive soda, sport drinks or energy drinks is unhealthy. What happens at school may be out of the immediate control of parents, but they can petition the school to eliminate vending SEPTEMBER 2015 | SAN MATEO COUNTY PHYSICIAN 9
ADOLESCENT RISK-TAKING IN THE AGE OF SOCIAL MEDIA
A
dolescence is often seen as a time of risk-taking and a necessary period of separation and individuation. In Lynn Ponton’s 1997 classic, The Romance of Risk, she states: “Frequent risk-taking is a normative, healthy developmental behavior.”1 There is nothing new about adolescent risk-taking. What is new is the playground where teens are exploring and expanding their knowledge about themselves and the world. by Gloria Moskowitz- Sweet, PPSC, LCSW, and Erica Pelavin, LCSW, PhD Today’s teens are using social media to socialize with their peers, investigate the world around them, try on new identities, and establish independence. As the playground has moved into the digital realm it has become necessary for practitioners to understand the social and emotional challenges that the “always on” generation face living in a 24-hour connected world. A teen’s social media life can be seen as a conduit that often mirrors their psychological profile. A vulnerable adolescent is often inclined to be at increased risk for victimization and likely to engage in risk-taking that may have serious negative consequences. For example, if a teen is struggling with an eating disorder in their offline lives, it is likely that they will seek support and get new ideas online. Understanding a “digital cry for help,” the apps teens use for support and affirmation, as well as nuanced language codes and hashtags, can help practitioners understand, diagnose and strategize treatment options.
Hiding behind the screen: anonymous sites and apps Although the digital landscape is ever changing, what seems constant is that teens are using multiple platforms to connect, explore, and in many cases step out of their comfort zone in an attempt to develop a
10 SAN MATEO COUNTY PHYSICIAN | SEPTEMBER 2015
sense of self. The anonymity of certain apps and sites allows teens to divulge parts of themselves they may hide in real life. Whisper and Yik Yak provide youth a platform to both process anxiety and find others with similar struggles or interests. The challenge with these sites often comes when anonymity leads to group cruelty. For a vulnerable teen searching for acceptance, this cruelty can lead to self harm and dangerous risktaking behavior. Ephemeral video messaging apps like Snapchat that promise to disappear within ten seconds can be a fun and quick way to connect, but can also cause impulsivity, such as posting nudes or sexts, which can lead to bullying, revenge porn (sexually explicit media that is distributed without the consent of the individual involved), and in some cases depression and suicide. Ask.fm, an anonymous question-and-answer site, gives youth the opportunity to give and ask for feedback in an unfettered environment. The anonymous nature of this platform often encourages them to be bolder—and, in many cases, meaner—than they would be offline. Most teens are not ready for the feedback they receive, yet are compelled to check what is being said about them. One teen stated, “I would rather know what people are saying about me than not know.” For a vulnerable teen searching for feedback, the consequences can be devastating.
Posting in the heat of the moment Live video streaming apps like Meerkat and Periscope can be a wonderful way for teens to explore and observe events around the globe. It can also lead to dangerous risk-taking behavior. As Periscope’s tagline declares, these apps let users “explore the world in real time through someone else’s eyes.” The risk of live streaming is in how and what the teen chooses to produce and watch. The viral nature of the internet can quickly set the stage for damaged reputations, cyberbullying, “slut shaming,” and in extreme cases suicide.
Sharing with strangers Online chat rooms such as Omegele and Ooovo can provide a place for teens to connect, exchange ideas, and try on new personalities. Chat rooms can also introduce teens to unhealthy risk-taking behaviors and the possibility of predatory relationships that they expand to their offline lives. Asking a teen where they go for online support is critical to unpacking their underlying issues or concerns. When talking about friendships, ask if they have met in “real life”; a reminder that teens may regard online contacts they have never met face-to-face as close friends.
Hashtags can be red flags
a movement dedicated to presenting hope and love to those who struggle with depression; The Trevor Project and the It Gets Better Campaign are national organizations focused on suicide prevention efforts among LGBT youth. Many teens find TED Talks or Tumblr (a service that allows users to post multimedia to a blog) to be helpful in making sense of their experiences.
Trying to obtain the unobtainable: Technoperfection
Children and teens are constantly bombarded with enhanced images in all forms of media that portray unrealistic standards of beauty. The abundance of digitally altered images and free apps that fix “imperfections” can lead girls and boys into believing that “perfect” exists. Facetune can remove acne, change eye color and whiten teeth; Pixtr automatically detects what needs to be corrected and alters it; Perfect365 removes dark circles under the eyes, and customizes the face with higher cheek bones and a smaller nose. Others include Mira Selfie Editor, Visage Lab Pro HD, Youcam Makeup, Photo Makeover, to name just a few. Encouraging a conversation on media messaging and technoperfection is vital in combating the rise in negative body image and Peer pressure and a quest for an unattainable standard of beauty, the desire to belong which can lead to eating disorders and body dysmorphic syndromes.
compel many teens
Identifying hashtags can be an important tool Online dares: Desire to be insta-famous: to push themselves in understanding the psychological profile of teens. If a teen is struggling with an eating to participate Offline dares have moved into the digital world. disorder, the “follower” might see hashtags With the hope of attaining fame, fortune and regardless of risk. such as #thighgap, #thinspro, #thinspiration, peer approval, many teens are taking online #ana, #bonespo, #hipbones #purge, #mia, dares, which are constantly changing as new #blades. Other hashtags can assist health care challenges emerge. Peer pressure and the desire professionals in identifying issues of self harm to belong compel many teens to push themselves and depression. Although some hashtags can be to participate regardless of the risk. Some of obvious: #selfinjury, #cuts, #helpme; others can these dares are positive and inspire social change, be more subtle and aimed at sending subliminal such as the Ice Bucket Challenge to support messages to their peer groups. A few examples ALS research. Others, such as the Cinnamon might include #selfhate, #sleepless, #heartbreak, Challenge, Cutting Challenge, Necknomination, #useless, #falling, #cantsleep and #killme. Kylie Jenner Challenge, Lies I Told My Parents, Hashtags might also be coded by the poster in The Knock Out Challenge and the Fire Ant an attempt to hide risk-taking behavior from adults and may Challenge can be harmful and for some teens extremely include #chirped = got caught, #420 = marijuana, #cu46 = see dangerous. In some cases teens record the challenge and post you for sex, #lmirl = let’s meet in real life. reaction videos for shock value or peer validation. The use Asking teens about popular hashtags within their peer group, what hashtags they use to connect with others, and how they are responding to comments can help uncover issues they are struggling with. In many instances there is an online alternative to sites that encourage negative risktaking and support the challenges the teen is experiencing with humor, respect, and helpful resources. To name just a few: The Butterfly Project is a project that can aid people who self harm to resist the urges; the Semicolon Project is
of devices such as the GoPro, a digital camera designed for filming action while being immersed in it, can encourage some teens to engage in experiences that could potentially be damaging or injurious.
Questioning with curiosity For today’s teens there is little or no separation between their online and offline lives. Because of the fast changing nature SEPTEMBER 2015 | SAN MATEO COUNTY PHYSICIAN 11
Adolescent risk-taking in the age of social media (continued from previous page) of the internet, what is popular one day might be passé the next. Our challenge is to enter their online world with the same curiosity and respect we give their offline world. Expanding questions to include a teens’ online life is imperative to obtaining a more comprehensive picture of a teens risk-taking profile. In many instances, today’s teens are seeking support from online blogs, famous YouTubers, Tumblr posts, and trending Instagrammers before they reach out to a person face-to-face. Learning about their online “friends” can be valuable to understanding the messaging, content and tone of the conversations they are a part of and the digital world in which they live. ■
References 1.
Ponton, Lynn E, MD (1997), The Romance of Risk: Why Teenagers Do the Things They Do, P6.
About the authors The authors are co-founders of My Digital TAT2 (mydigitaltat2.com) in San Carlos, which offers workshops, professional training, and clinical services to help youth develop the skills to manage their own privacy, respect the privacy of others, and use cyber-sense and ethical decision making in their digital lives. Gloria Moskowitz-Sweet, LCSW, PPSC (right), is a school social worker, educator, program developer, and university lecturer with expertise in understanding children’s learning styles and multiple intelligences, fostering resiliency in children, bullying and cyber-bullying prevention, and educating children and youth to be ethical and responsible digital participants. Erica Pelavin, LCSW, PH.D, is a family psychologist specializing in bullying prevention, relational aggression, digital drama, cyber-safety and conflict resolution.
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SMCMA welcomes new members
SMCMA Seminar MERGING PRACTICES: STRATEGIES TO REMAIN INDEPENDENT
Daria Maldonado-Knapp, M.D. *Dermatology- Burlingame
Farah Salahuddin, M.D. Rheumatology - San Mateo
In this new era of health care, consolidating practices can result in economies of scale, reduction of overhead, increased power in contracting, increased net income, ability to recruit new partners and retire partners. But as in a marriage, good communication and shared values are key to compatibility and long term success. This workshop covers practical strategies to manage a successful merger. Presenter Debra Phairas is President of Practice & Liability Consultants, LLC, a nationally recognized firm specializing in practice management and malpractice prevention.
Owen Palmer, M.D. Vascular Surgery - Redwood City
Shalu Patel, M.D. *Emergency Medicine - Redwood City
Swetha Thota, M.D *Family Medicine - San Bruno
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Wednesday, October 14, 2015 - 6:00-7:30 p.m.
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San Mateo County Medical Association 777 Mariners Island Boulevard, #100, San Mateo
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SMCMA Members/Staff: $99 - All others: $249 Refreshments will be provided.
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To register, contact us at (650) 312-1663 or visit smcma.org/calendar.
Jimmy Truong, M.D. *Family Medicine - SSF
*Certified by the American Board of Medical Specialties
In Memoriam Ephraim P. Engleman, MD September 2, 2015
Tracy Zweig Associates INC.
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Artwork/Photography in this issue Front cover, page 3: Untitled photo by April Bern, 2011. Page 6: Untitled photo by Liz Lions, 2011. Page 8: “Beautiful Soda Shelves II” by A. Olin, 2014. Page 10: “It’s Always Sunny in Honolulu” by Justin De La Ornellas, 2011. Used with permission under Flickr.com Creative Commons license.
INDEX OF ADVERTISERS Cooperative of American Physicians.......................Inside Back Cover The Magnolia of Millbrae............................................................................. 10 Mercer................................................................................... Inside Front Cover NORCAL............................................................................. Outside Back Cover Tracy Zweig Associates.................................................................................. 14
14 SAN MATEO COUNTY PHYSICIAN | SEPTEMBER 2015
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