On what we teach about sex

A few incidents in the last few years of work have made me wonder about the different ways and the different things that parents educate their children about sex. There’s the biological stuff, which is what parents for some reason think is most confronting, but that every single generation in every single country and in fact every sexually-reproducing species since the beginning of animal existence has figured out quite easily. A parent could get away with not ever mentioning to their offspring how babies are made, where they come out of, and the logistics of what sexual intercourse entails, and they’d pick it up anyway. I mean, in most cultures before our grandparents generation such things weren’t discussed by parents with their children – and yet people still had sex and had children, etc. It’s even less of a concern in modern days where there’s television and other media, there’s schools purposely teaching this stuff, and there’s other people (e.g. peers, relatives, health professionals, etc.) who will readily discuss the biology of sex with anyone. So it’s not what we teach children about the physiology of sex that concerns me, but that other stuff we tend to forget about sometimes, the psychosocial aspects of sex in a person’s life.

To go back again to the “olden” days now. Religion used to be a big part in a greater proportion of people’s lives ‘back in the olden days’. That’s a fact, that less people these days than, say, 100 years ago had a religious affiliation, whether that be because they elected to or were expected to by state mandates. In most religions, sex has/had a spiritual connotation and there were rules and consequences described around it. If you had sex before a marriage was confirmed, with someone outside of that marriage agreement, etc. you had “sinned” and would incur a punishment for it. Now, the punishment would be either or both imposed upon you by the church (e.g. been disassociated from the congregation) or by God (e.g. you were lead to believe that God would punish you by disapproval or loss of a post-life privilege, dependant on what the religious creed was). For the non-religious (and of course still applied to the religious) in ‘the olden days’, there was this thing about reputation and social norms.  Of course, social norms and expectations (as does religion) still exist, but modern Western culture places less of an emphasis on it, and more on being your own individual. So our parents and grandparents generation placed greater emphasis on whether others thought or knew that you had been engaging in something as disreputable as having sex with someone you weren’t married to. Sex was a shameful thing. Even for those that were married, it was not a proper thing to discuss or make jokes about or depict in media or entertainment, etc. So, back in the day a parent who educated a child about the psychosocial aspects of sex (the physiology been much too embarrassing to discuss outside of biology classes or by scientists), all you had to do is tell the child not to have sex because they’d either go to hell and die or that the whole town would call them a slut and their life would be miserable.

What are we teaching our children now about sex? Everyone knows about the physiology of sex, even very young children, and parents and their children will share very explicit details about sex. What’s wrong with that? Nothing – except that sex to human beings isn’t just about the biology of it. There’s nothing wrong with having all this knowledge about sex at all! But I’m beginning to believe that we’ve taken too much comfort in only sharing the easy stuff about sex, the stuff every child will eventually figure out even if their parent never tells them about, and have left our children with the hard stuff to figure out on their own.

In my job I’ve met many teenagers having absolutely never considered some of the other consequences of sex, let alone how to deal with them. We teach our children about sex, what it entails, that there’s the possibility of pregnancy and infections, to use condoms to prevent infections, and to use contraception to avoid pregnancy. But where children are missing out on instruction is about romantic relationships, who to have sex with, why or why not to have sex, how is sex related to love, should sex bear any relationship to love at all? These are all questions that increasingly younger people are having to charge through on their own. And I’d like to share with you some examples of questions that I have witnessed some very anxious teenagers try to deal with on their own too:

• How do I tell my parents I’m pregnant? Do they need to know?
• How do I tell my ex-boyfriend that I’m pregnant? Should I tell him?
• Should I tell my parents or my ex-partner/s that I have and STD? How can I tell them?
• Why did I get an STD when I was with a person I loved?
• Should I quit school because the other students won’t stop bullying me about being pregnant in high school?
• Is it ok to be sad about having a miscarriage even though no one else knew I was pregnant?
• What do I do now that I’m pregnant and my parents don’t want me to be and I still haven’t formed a concept on how I feel about abortion?
• How do I tell my girlfriend without hurting her feelings that I think she has a problem ‘down below’ because those warts don’t look normal?
• How can I get an STD when I use a condom all the time except with my regular girlfriend and she isn’t with anyone other than me?
• Is sex always meant to be painful or is it just because I don’t actually want it when it happens?
• Is it normal not to have had sex yet at my age? Does that mean I am lacking something or am sick?

Can a parent or anything in life prepare you to answer those questions? I don’t know. But it certainly would break your heart to have first considered questions like these when they apply directly to you and the situation you find yourself in. I say, good on us for talking to our children openly about sex and the need for safe sex practices and why they’re important, but it’s now time to do the real hard work: prepare our children to think of the consequences if they do find themselves in situations where the safe sex has simply failed. Encourage the young person to think of their own opinions about abortion, about social discrimination against teen parents, about sexually transmitted infections, about the link between love, sex, and relationships, about the effect on career development and parenthood, etc. We don’t need to mandate our kids to the effect of “don’t have sex or you’ll die”, but we could encourage them to ask themselves “could I deal with any of the consequences of sex? If not, then do I need to delay sex for now?” And do this not because the child will go to hell or society will ostracize him, but because he is an independent being worthy of not suffering the negative consequences of sex.

On prescription drug abusers

Every now and again all doctors will come across a person who wants to access prescription medications for the wrong reasons. Some people will want them to feed their own personal addictions, and others will resell them for a profit on the streets. Personally, I am never one to judge people for their weakness or for their lifestyle choices, yet this scenario bothers most doctors for a variety of reasons. It bothers me because the false stories these people tell will make me second guess and misjudge the person who tells the same story but it is true and they have a real need for these medications. And, yes, it is also frustrating to have to deal with patients who are lying to you or who abuse your trust or become aggressive/threatening when you challenge them or deny them what they want when all you’re trying to do is get on with your daily job.

There are some government systems in place to help doctors identify people who abuse prescription drugs, but unfortunately they have big limitations. The biggest reason they probably don’t work is that a doctor has to first decide to enquire with them about a specific patient. Now, the patient who is a prescription drug abuser usually knows how not to arouse suspicion from doctors – therefore the doctor never decides to check their background! In medical school they taught us some basic things that should arouse our suspicion that a patient may be a drug abuser, but most drug abusers have figured these out and found ways to deal with us to make us believe they aren’t one of those people we learnt about all those years ago. For example, some of the things we were taught are that drug abusers tend to:

•          book the last appointment of the day (no, not anymore. If anything, they tend to be morning people)
•          ask for specific medication (they know how to calculate equivalent doses of whatever you give them if it’s from the same drug class. They also know to ask for an NSAID and paracetamol along with their opiates and benzos)
•          can’t back up their stories with clinical data (they have scars to prove the “surgery”, the medical report from the hospital, the clinical signs on examination, the old packets of the medication they have been prescribed, the imaging report, the name of the interstate specialist who looks after their condition but is unfortunately unavailable right now, etc.)
•          they become angry if you question them about drug abuse (“Oh no, doctor, not me. You can even call my specialist – oh wait, he’s not there today”…)
•          refuse referral or liason with other clinicians (you have to admire these guys’ confidence in their lies. I once was  informed by a hospital oncology department that I was the 15^th GP that week that had referred a patient for urgent review– a patient who did not actually have the metastatic cancer the CT report he provided from his interstate doctor, a doctor who knew nothing of the patient either)

Most doctors agree that a solution to the problem of prescribing to patients who abuse prescription medications is to have a real-time system of prescribing where the doctor is alerted to how many times a drug of abuse has already been prescribed to a patient. Would it work? Maybe, or maybe not. I hope it does if it's ever introduced.

To be honest, what bothers me most about the issue of prescription drug abusers is not that I was once duped by an amputee who claimed to be a war veteran but who had in fact lost a limb from intravenous drug use related disease (and not a war injury as he claimed) and I gave a script for opiates to. But that that experience made me doubt the next amputee war veteran I saw who had lost his limb through war injury and had severe phantom limb pain for which his pain specialist had prescribed a whole concoction of drugs, including opiates. Had his specialist not been available and his story backed up, I may well have let him go without receiving the proper medical care he deserved. That is my greatest fear regarding this: not that I feed a junkie’s addiction, but that I commit an injustice to a real and deserving patient.

On the jobs we do

A quote often attributed to Walt Disney is to “find a job that you like so much that you’d do it without compensation; then do it so well that people will pay you to continue”. Recently, a few people have asked me for advice (and also simply discussion) on career choice. Until not long ago, I believed that career choice should be based on one thing only: passion. I have now come to consider that there are many ways to live a life – and not all are based on career choice. So instead of just discussing jobs today, I want to discuss satisfaction and success in life.

What is a successful life? Well, in the world we live in and the story the media feeds us success is measured in dollar value, in popularity, and in gaining the admiration of others. We think of successful people as entertainment performers, businesspeople with lots of wealth, and sportspeople who win competitions. But what really is success? In the simplest sense of the word, success is about having a goal and achieving it. A successful person, therefore, is someone who attains a goal they set about to achieve. In this is sense it is superfluous for anyone of us to call someone else successful unless we know what their goals and passions in life truly are.

One thing is deciding on a career choice, and quite another is having a fulfilling and successful life. Career choice is easy; the only thing hard about it is deciding what importance you place on a job in your life. To summarise I put it this way, there are three types of people in the workplace: You are either the kind of person where 1) Your job pays your bills so that you can engage in the things that bring you true fulfilment, 2) Your career is what brings you fulfilment and the rest is “merely living”, or 3) You are of that tiny minority that generate both an income and derive true pleasure from your job. Neither of these modes of thinking about your job are “good” or “bad”, they’re just the decisions we make. The choice doesn’t matter, but what will make you a miserable person is being one of these three people, but working a job out of sync with what your beliefs are.

Living to work

The first kind of way to live a life is to live for your work. What I mean by this is that your job is what gives your life meaning and a sense of fulfilment. Of course, life isn’t just about jobs and careers but there is nothing wrong with having your job as the priority in your life. Not all of us can and I couldn’t and wouldn’t want to, but that is not to say that this is a bad thing.

I have read a fair bit about Temple Grandin, a highly intelligent and proficient woman with autism. She dedicates her time to helping animals, designing animal-friendly farm equipment, and the study of many scientific subjects. Someone once asked her if now that she has all these university degrees, money from her businesses, does she not want for more in her life. Does she not want love, a husband, children? No; she says she didn’t. She feels complete and fulfilled. Her life is successful – and there is nothing wrong with that! I have incredible respect for Temple Grandin.

Working to live

You meet the most wonderfully creative people working jobs waiting tables and selling you movie tickets and cleaning your floors and dishes. To most people these are “menial” jobs, or money jobs. Rarely do people desire an entire career or lifetime doing these jobs, but the truth is that they do put food on the table and pay the rent, etc. Now, don’t get me wrong, I’m not saying everyone who works these jobs are secretly creative geniuses by night or anything like that. But having some money around is helpful to anyone, particularly if you are trying to also be creative in your own time and at your own pace without the pressure to make a living from your creative or humanitarian or whatever other endeavours. The downside to having a “hobby” is that unfortunately many so-called unskilled jobs come with menial wages and the struggle to survive on this can come to kill the most well-intentioned creativity. The instinct to eat is almost always greater than the instinct to express yourself or help others. And yet it’s not always about creative expression.

 

Many times I have craved in difficult times a job that didn’t require me to think about it after I leave my jobsite, that people’s health/life weren’t dependent on my decisions when I felt unsure, or that I could afford more time spent at home. Spending less time and relative effort on the thing that only brings you income has the advantage to allow you to build the wealth that may be of more value to you: true human warmth, compassion, caring, and the sense of belonging to a family where every member is crucial and appreciated. Personally, family IS of great value to me. Working to live is about working a job for an income so that you can afford (cognitively and emotionally too, not just financially) to do the things that bring you true fulfilment.

Working with passion

The quote I mentioned at the start is essentially about getting paid to fulfil your passions, and that is the last scenario I want to consider. At first you may think that I have already spoken about this when I discussed living to work, but this a bit different. I often meet people who tell me “I wish I could have been a …” and no matter what their age I always ask them why they’re not. The responses I can tell you are almost always excuses and not reasons.

There is a minority of people who won’t make excuses, and they become the people who reach the summit of their chosen careers. In any field of industry (but particularly in sports, performance arts, and business), the general trend is for there to be many people in the lower ranks of industry trying to make it to the top - and there are just very few spots at the top. It is, of course, very easy to become discouraged by the numbers, the statistics, and the probabilities. And we’re very good at thinking of reasons why we can’t succeed and imagining stories other than the truth of why others did/do succeed. The actual truth, though, is that there are no easy ways to the top – and accepting that challenge because of a burning desire to reach that top is what will give you the strength to overlook the statistics and probabilities. Isn’t that a foolish thing to do, though? I mean, what if you die and you have never reached that summit you desired so much? Isn’t your whole life a failure then? I pondered this once, actually (and, yes, probably because I was looking for a reason to give up), and it was just at the time I watched a news report on some military officers who died in battle. I realised that the news reports kept referring to them as war heroes, brave people who had made the ultimate sacrifice for something they believed in. Of course, in military terms the goal is to win the battle – and if you die trying you’re not considered a loser, but a hero. Yes, a hero, a successful person! Do you see what I’m getting at?...

But the damn statistics loom over your head always like a horoscope. Very very few people make it to the summit of their chosen career field – but those who do didn’t get there by accident or just by wishing it so. In medicine I’ve had colleagues tell me about the disheartening statistics: they want to be a specialist in this field but there’s only so very few people who get this job in Australia. My answer to them is always the same too: “yes, and why can’t that person be you?”. Why? Oh, yes, we are all very good at thinking of reasons why others are successful and we never will be. Others slept with the boss, probably; they are smarter than us; they have a postgraduate qualification we don’t have; their parents know people who know people, etc. I guarantee you that if you meet the people who are at the top of their field of industry and actually ask them how they got there, few will tell you that it was because they were “just lucky”. No, they will tell you of their struggle, their sacrifices, and their previous setbacks. What I’m saying is that if you are truly in your heart passionate about a specific career, then what you need to focus on is being the one in the statistic, and forget about whether it is out of a hundred, a thousand, a million, or however many billions.

Living with passion

So far I have only spoken about work, but for most people work is only one important aspect of living, not the most important. And I think the whole question of “what career is best for me?” is better rephrased into the key question “what do I want a career to give me?” There are many ways to live a life and many different types of jobs out there, but only a person can decide for themselves what role a job plays in their life with regards to satisfaction, overall life goals, etc.

For the greatest majority of people our goal in life is to be happy and not to be miserable. If you have a passion in life, a passion without which your life will seem miserable to you, then you have an overwhelming desire to fulfil this one task. If that is you, then you (have to) become the person who won’t take no for an answer. You become the kind of person that doesn’t believe in failure only as-yet-unsuccessful attempts. You have to become resilient and keep trying until you can attain the “job” of your dreams. And note that by “job” I mean any task in life that you are passionate about; could be a paid job, could be to be a mother, could be to create something, it could be anything at all. But I can tell you that living with passion is such an empowering and enriching way to think of life. You could die trying to succeed and know that you’ve already succeeded!