A month earlier, I heard about another college student who was riding his bicycle home to his apartment when he was kidnapped at gunpoint and thrown into the backseat of a car.  He was driven to several ATM machines in an attempt to extract money.  He was lucky – they let him go. But will he or his family ever feel safe again?

When Did It Start?

Hazing, an act against someone in order to initiate the person into an organization, is not new. Schools in ancient Greece and medieval Europe called it pennalism and adopted it as a requirement for graduation. In 1845, Amherst College administrators wrote a letter to the families and parents of students informing them that, “we merely desire you know what dangers attend college life,” for students were practicing personal habits that were “unfavorable to study and morality.” Professors and college presidents felt they were dealing with students whose behavior was beyond their control. Fast-forward 150 years. Do administrators and parents have similar concerns today?

The sad truth is that a student can graduate from college worse off physically and psychologically than when he or she entered. In an ideal world, in addition to academic learning, college would include a “health benefit.”  Students would successfully separate fact from fiction about sexual activity, smoking, drinking, risk taking and limit-testing.

The Dangers of Hazing

Hazing is not just a part of the fraternity and sorority community, but is also deeply embedded in sports, military and service organizations.  The premise is that hazing increases group cohesiveness while promoting respect and loyalty for the organization.  Supporters of hazing point to these positive attributes and add that hazing often includes maintaining grade point averages, community service, tutoring or fundraising.  But, the dark side of hazing is dangerous and can result in physical and psychological damage, even death.

One study revealed that students are neutral about hazing and that their definition is quite narrow, including only extreme forms like beatings or rape.  Students may not recognize the psychological abuse involved in their pranks.  Besides hazing, many students fail to recognize the risks of their health-related decisions like alcohol consumption, smoking and risky sexual behavior. Many colleges focus on the Greek system and varsity athletics and fail to notice the other campus organizations’ activities and health risks.

Like domestic violence, hazing injuries are under-reported because of embarrassment, a desire to protect others, or a desire to be accepted by the organization. But illegal hazing, sexual assaults and alcohol injuries need to be reported for criminal investigation and not just handled by the University.

Dr. Richard Senelick

It’s Not Just Hazing

College life is filled with other dangers.  Women are at an increased risk for sexual violence and abuse. Alcohol abuse increases in the transition from high school to college and this can contribute to the sexual victimization of women. For some, binge drinking becomes a way of life. A recent study in Buffalo New York reported that 22% of young women experienced sexual victimization during their freshman year and 38% of these women reported severe sexual victimization. Serious dangers may surround the tranquil ivy lined confines of a college.  Students who venture off campus or commute from apartments that are off campus can be at risk. A Justice Department study reported that men were twice as likely as women to be the victim of violent crime and that 58% were committed by strangers, 41% of the offenders were using alcohol or drugs, 93% of the crimes occurred off campus and 72% occurred at night.

What are the Solutions?

The Jeanne Clery Act is named in memory of a 19-year-old Lehigh University freshman who was raped and murdered in her residence hall in 1986.  As a result of this law, schools are required to report all crimes and violent activities. Unfortunately, statistics alone will not stop the problem, and education is far from enough to stop bad behavior.  However, a “zero tolerance” policy is difficult to enforce as students may resist change and do the opposite to protect their own beliefs and opinions. Hazing and injuries often continue despite the fact that colleges have strict regulations to protect their students. In the meantime, here are some common sense tips to share with your college student:

• Know your alcohol limit. Bad things happen when you are intoxicated and you are never quite as attractive or clever as your drunken self believes.
• Sexual abuse against women occurs almost universally under the influence of alcohol and involves someone they know. Limit your drinking.
• Go out in groups, particularly at night. Remember, you may not know the people around you as well as you think you do.
• Be aware of your surroundings. Have your keys out and walk with confidence– head up and briskly.
• Avoid walking while wearing headphones or using a cell phone, as it distracts you from your environment. I know this can be a hard one!
• Learn to say NO!
• If it feels wrong or uncomfortable, leave.
• Acquire friends outside of your fraternity, sorority or sports team.  They will help give you perspective.
• Keep your door locked.
• Take a self defense course.

For most people, college is a wonderful time of intellectual and emotional growth.  A few precautions will help keep it that way.

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Dr. Richard Senelick with patient

Dr. Richard Senelick discusses the case for formality in the doctor/patient relationship

I’ve never had a good nickname. My Gramps has always been one of my heroes and he called me “Dicky” until the day he died. I loved my Gramps, but as I grew older, went to medical school and donned my starched white coat, the nickname didn’t seem quite right. In high school I was Rich and Richie, but fortunately my wife saw fit to call me Richard and it stuck. I like being called “Doctor,” but must admit that I would trade it all in a heartbeat for an interesting, ear snapping nickname.

Related: How to Protect Your Child From Hazing, by Dr. Richard Senelick

The Office Visit

I like to wear a carefully selected necktie and put on my starched white coat with “Dr. Richard C. Senelick, M.D.” embroidered neatly over the right breast pocket. Last week I walked into one of my exam rooms to greet a new patient – a young man in his mid twenties. Here is how the situation played out.

Me: Good Morning Mr. Smith, my name is Dr. Senelick. I understand that Dr. Jones wanted you to see me today.
Mr. Smith: Good Morning, you can call be Bob.
Me: Bob, I will do that. What seems to be the problem?
Mr. Smith: Well, Richard, it all started a month ago…

Wait – what did he say? Richard?

Are their new rules in the digital/casual age? I was trying to figure out what made me feel uncomfortable, and whether Bob had an agenda or if he was merely working from the much more informal viewpoint of his generation.

_______________

The Doctor/Patient Relationship

Dr. Richard Senelick with a patient

The doctor/patient relationship is highly personal and complex. Patients disrobe and endure being poked and prodded in embarrassing positions and locations. They must feel comfortable relaying their most intimate information to someone who may be over 30 years their junior. Through all of this, the physician must maintain a professional rapport and the patient’s dignity, respect the person’s privacy, and convey an impression of competence.

We may see our peers as both friends and equals, and feel comfortable always using their first names. However, at work the boss or supervisor may be referred to by their last name while the employees are called by their first names. It takes us back to childhood days when adults always called children by their first names, but cringed when their son’s friend calls them by their first name. Does a physician who wishes to be called “Doctor,” but calls patients by their first name, reflect a similar position of authority or superiority to this adult/child dynamic?

Related: Does Your Doctor Really Listen?

Here is a bit of “armchair sociology” that has no scientific basis. I see no evidence that informality makes a positive contribution to the therapeutic experience. If I call a patient by their first name, it would seem only fair and equal that I offer up my first name. I have always addressed my patients by their last names and titles, particularly in San Antonio, Texas, where military titles are extremely important. Familiarity also seems inappropriate in an environment where the patient does not see the same provider at each visit and has to start from scratch. Long gone are the days of a family physician who cared for three generations of the same family. Since a sizeable portion of patients and physicians may be offended by the use of their first name, it seems best that, unless invited to do so, we stick to formal titles.

_______________

Just a Bit Too Casual

Dr. Richard Senelick

I just can’t resist a few words about the young doctor who walks into a patient room in jeans, collarless tight fitting shirt that shows off his hours in the gym, and the latest, electric blue, cross-fit training shoe, socks optional. You can call them Doctor Ed, Jim, Sally or Maria – I have seen them all. In an article “Patient and House Officer Etiquette on Physician Attire and Etiquette” published in JAMA 65% of patients wanted their doctor to wear a white coat and 52% objected to their physician wearing jeans. While this was before the days of $200 designer jeans, I imagine it still holds true.

Related: You Can’t Have Too Much Hope, by Dr. Richard Senelick

We cannot ignore the imbalance in the relationship between the physician and the patient, but it is the obligation of the physician not to take advantage of this imbalance. The nature of a physician’s or nurse’s attire should not be about their personal comfort, but about adjusting to what makes the patient comfortable. There is no doubt that this will vary amongst different cultures and geographical areas, but healthcare professionals must meet the needs of our most conservative patients. I have never had anyone object to my tie, white coat and a respectful greeting.

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Mark Kelly at the side of wife Gabrielle Giffords in the University Medical Center/ U.S. Rep. Gabrielle Giffords' Office

Do you believe it?  Mark Kelly does.  He is the astronaut husband of Rep. Gabrielle Giffords who expressed this sentiment the other night when he and his wife, Gabby, were interviewed by Diane Sawyer.

There are several remarkable aspects of their journey from her near fatal gunshot wound to her brain ten months ago to sitting on a couch next to her husband, smiling into the camera at millions of viewers. What lessons can we learn that we can translate to our own experiences with injury and illness?

Related: Our Interview With Arizona Shooting Survivor Ashleigh Burroughs

Mark Kelly told us that as an astronaut he never considered that the “sky’s the limit.”  If there was a limit, he never would have been circling the earth in outer space.  He knew that from the minute that Gabby was injured that they were “beaten up” but not “beaten.”   We do this do ourselves all the time-we set artificial limits that may keep us from achieving better outcomes and our ultimate goals. The student who fails to continue their education or the patient who drops out of therapy because the tasks seem too difficult.

The message is clear: don’t give up. Once you achieve a goal, move forward to the next goal.  This is crucial after a brain injury or stroke, since experience tells us that therapy is frequently discontinued when there is still much to accomplish.

Dr. Richard Senelick

I tell patients and families that rehabilitation will be the hardest work they will ever do.  The Giffords provided a tremendous service to disabled individuals all over the world by sharing their video record of their journey.  You might say that Mark Kelly is wrong and that a person can have too much hope.   You need to ask yourself whether you are thinking that a task will be too difficult to perform so you dare not hope to achieve it.  Gabby Giffords tells us at the very end of her interview that she wants to be “Better-stronger” and then immediately follows it with the statement, “hard-hard!”

We know that optimistic people are healthier, have fewer heart attacks and strokes and do better in rehabilitation.  Webster’s dictionary defines hope as “the feeling that what is wanted can be had.” Achieving those goals can be difficult and it helps that Gabby Giffords has a remarkable partner to support her journey toward what the new WebMD Disability Blog describes as a “Different Normal.”

Don’t give up on your dreams to get better because Mark Kelly and Gabby Giffords are correct, “You can’t have too much hope.”

Related Links on genConnect:

• Gabrielle Giffords Shows Up for Debt Limit Vote After Shooting
• Husband: Rep. Gabrielle Giffords Still an ‘Incredibly Positive Person’
• Rep. Gabrielle Giffords Asks for Toast for Breakfast

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