Talking About Physician Burnout, and Changing the System

Dear Readers,
I have a new story at the Atlantic Health. It’s on burnout among physicians. The problem is clear: Too many have a hard time finding satisfaction in the workplace. Many struggle with work-life balance and symptoms of depression.

With many difficult situations, the first step in solving a problem is in acknowledging it exists. After that, you can understand it and, hopefully, fix it. Our health care system now, as it functions in most academic medical centers and dollar-strapped hospitals, doesn’t give doctors much of a break, or slack, or “joy,” as Dr. Vineet Arora suggested in an interview. You can read about it here. The implications for patients are very real.

Glad to see that research is ongoing about physicians’ stress, fatigue and depression. Thank you to Drs. Tait Shanafelt, Mary Brandt, Vineet Arora and others for addressing these under-studied and under-discussed issues in medicine. Through this kind of work, policy makers and hospital administrators might better know how to keep doctors in the workforce, happy and healthy.


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Living Like It’s Shark Week, Take 3

It’s Shark Week, or at least that’s the situation over at Discovery Channel. The annual, virtual immersion into the world of cartilaginous fish has been adopted by your author as some sort of metaphor, but she’s not sure for what.

“Live every week like it’s shark week” is a puzzle. In fact, this statement in a 30 Rock episode lurks at the periphery of Medical Lessons year-round. By now I should confess I’ve never watched an entire Shark Week program. But that doesn’t stop me from wondering about the significance.

Remotely, it’s about mental health. Science, too. I could head into a discourse on cartilage and the alleged beneficial effects for illnesses like cancer, but I don’t believe there’s any evidence to support those claims. Surely, Shark Week has to do with whether you embrace more risk or take a safe route, swim where divers go or watch TV about nature. At another level, it’s about time – a reminder that there are only so many days and nights in each week, in each month, in each year, by which we mark our lives.

So it’s about mortality. Maybe.

An alternative theory is that Shark Week is entirely devoid of deep meaning. It could be nothing more than a tool by which the Discovery Channel turns a profit in August. This year, the event was delayed until August 12. Although I’ve never taken a course in cable network programming, I would hazard a guess that this scheduling change had to do with the end of the Olympics programming that same day.

For 2012, I’ve decided to celebrate Shark Week by not watching TV. Furthermore, I won’t write on anything that has to do with breast cancer or hard science. This morning, I walked to a beach and went for a swim before breakfast. It was fantastic.

Enjoy August! And please rest up, dear readers, because I’m likely to get serious again, soon,


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Cyberchondria Rising – What is the Term’s Meaning and History?

Yesterday the AMA news informed me that cyberchondria is on the rise. So it’s a good moment to consider the term’s meaning and history.

Cyberchondria is an unfounded health concern that develops upon searching the Internet for information about symptoms or a disease. A cyberchondriac is someone who surfs the Web about a medical problem and worries about it unduly.

Through Wikipedia, I located what might be the first reference to cyberchondria in a medical journal: a 2003 article in the Journal of Neurology, Neurosurgery, and Psychiatry. A section on the new diagnosis starts like this: “Although not yet in the Oxford English Dictionary, the word ‘cyberchondria’ has been coined to describe the excessive use of internet health sites to fuel health anxiety.” That academic report links back to a 2001 story in the Independent, “Are you a Cyberchondriac?”

Two Microsoft researchers, Ryen White and Eric Horvitz, authored a “classic” paper: Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search. This academic paper, published in 2009, reviews the history of cyberchondria and results of a survey on Internet searches and anxiety.

Interesting that the term – coined in a newspaper story and evaluated largely by IT experts – has entered the medical lexicon. I wonder how the American Psychiatry Association will handle cyberchondria in the upcoming DSM-5.


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iPod Therapy – Why Not Prescribe It?

Yours truly, the author of Medical Lessons, is listening to music while she writes. A live version of the Stones’ “Silver Train” has just come on, and she’s happily reminded of something that happened 30 years ago. Distracting? Yes. Calming? Yes. Paradoxically helps to keep me on track? Yes.

My iPod keeps my mind from wandering further. And it lifts my mood.

And so here, on my blog, which is not peer-reviewed or anything like that, I put forth the medical concept of “iPod therapy.”

“When you’re weary, feeling small…” Music can help.

Today’s news reports that 1 in 5 Americans take drugs for psychiatric conditions. That sounds like a lot to me, but I’m no pharmaceutical surveyor. Of course many people need and benefit from medical help for depression and other mental illnesses.

But, in all seriousness, I wonder how many people might use music like a drug to keep them relaxed, happy, alert…

Why not prescribe music? It works for me, n=1.

Maybe doctors should be recommending iPods, or radios, or Pandora to some of their patients who are feeling down. I hope an academic psychiatrist somewhere, without ties to Apple or Pandora or Bose or other relevant party is coordinating a careful, prospective study of this promising and relatively inexpensive intervention.

As best I can tell, music is non-addictive. Except that if I had to live without it, I’d start humming, or maybe singing, which might be detrimental to those who live near.

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Thoughts on the Death of Amy Winehouse

I feel compelled to write at least a short note on Amy Winehouse, a young woman who was found dead in her London apartment a few days ago. I don’t like to speak ill of the dead, but the truth is I was never a big fan of her music. I wasn’t fond of her highly-stylized hair or her weirdly-curved eyebrows.

Once, when I was 17, a friend told me he always tries to see the good in people, no matter how much they behaved disagreeably. Ever since he said that, it’s stuck. Today his words come through, in contemplating Amy Winehouse’s personality and short life.

I like her for her willfulness, even though it was so destructive.

Amy Winehouse, in 'Rehab' Video

Not a good medical lesson, for sure – or the message most people are telling their kids upon this “teaching moment,” but not everything I care for is just how it should be.

Yes, she should have gotten more help for her addictions. She needed it, that’s obvious. Family and friends, take note!… You can intervene and make a difference in a troubled person’s life.

But sometimes this happens in medicine, when you’re caring for a patient who smokes or drinks or smokes and drinks or does something else unhealthy, or in a family, or among friends – it’s not always so helpful to simply criticize and judge or lecture and point the person to the door.

So here’s another take: to identify something good in the person, and focus on that, and remember that.


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Psychology Colors and Emotions, from the Late Dr. Robert Plutchik

This morning’s med-blog Grand Rounds is up at MedGadget, where my colleague Dr. Nick Genes has put together a nice assortment of reads. One entry refers to the Plutchik Emotion Circumplex – “a wonderful graphic representation of a highly regarded emotion classification system.”

Plutchik's diagram, as featured in his book: "Emotions and Life: Perspectives From Psychology, Biology, and Evolution"

I never took psychology in college, and in med school they sent us straight onto (into?) the psychiatry wards. For whatever reason, I wasn’t familiar with the colorful schematic. Here’s what I learned today:

Dr. Robert Plutchik was an academic psychologist and author best known for his work on the nature and evolutionary aspects of emotions. He was a Brooklynite who attended City College, received a Ph.D. from Columbia University and became a professor at the Albert Einstein College of Medicine. According to an obituary in now-defunct New York Sun, after retiring he moved to Sarasota, Florida. He died in 2006, at the age of 78.

From the Sun:

He was best known for his theory, laid out in “Emotion: a Psychoevolutionary Synthesis” (1980), that there are eight primary emotions, which can to some extent be recognized in all animals. These are joy, acceptance, fear, surprise, sadness, disgust, anger, and anticipation. It was Plutchik’s insight that emotions could be laid out in a circular arrangement, much like a color wheel, and then combined into secondary emotional states. Love, for instance, was in this schema a combination of joy and acceptance. Delight was a combination of surprise and joy.

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Until Tuesday, A New Book About a Very Strong Person

A short note on a book party, fundraiser and warm celebration I attended yesterday evening. My first Facebook friend, Luis Carlos Montalván, an acquaintance from my experience at Columbia’s Journalism School, has published a wonderful book, Until Tuesday (Disney-Hyperion).

I received a copy of the book at the gallery, and couldn’t put it down. Luis, a seasoned veteran and former Captain in the U.S. Army, earned the Combat Action Badge, two Bronze Stars and a Purple Heart medal. He was severely injured during his deployment in Iraq, and came back with deep emotional and physical wounds.

His wonderful book is a tale of healing, aided by a special dog, but really it’s about human healing, and Luis’s determination to get well.

I am inspired by Luis, first that he got his book out (he beat me to it!), and also for being so brave in telling his story. It’s not an easy one, but it’s intense and will forever influence how I think about soldiers.

“Some people in the room know that every day 17 veterans commit suicide,” he mentioned to the group. I wasn’t aware, until yesterday.

For those of you who missed the party last night, you can check out this clip from CNN this morning, but of course it’s not the same as meeting Tuesday in person.

Thanks Luis, for being so forthcoming, and strong!



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Noting Depression in Susan Glaspell’s 1917 Story: A Jury of Her Peers

Recently I read the short story, A Jury of Her Peers by Susan Glaspell, with a group of women in my community. The author, with whom I wasn’t previously familiar, first reported on the real 1901 trial of Margaret Hossack, as a journalist writing for the Des Moines Daily News. Later she adapted the story as a one-act drama, Trifles, and then in 1917 as a short narrative published in Everyweek, a long-defunct magazine of the Crowell Publishing Company.

Original performance of "Trifles," (from the Billy Rose Theatre Collection, New York Public Library at Lincoln Center)

There’s a lot you might take from this swift, rich read. It goes like this: A man and his son came upon a couple’s house in rural area. The man’s been killed, clearly; his wife sits in a chair, oddly, and can’t say what happened to her husband. The local authorities and a few neighbors step in. The home was not well-kempt; the wife is accused of murder. Two other women, whose words spin the tale, poke about the kitchen and make inferences about the jailed woman’s circumstances.

Some points are readily gleaned: on homemaking, and quilting – literally and metaphorically, in early 20th Century America. There are legal elements, and allusions to domestic violence and abuse. What intrigued me most, though, was the author’s indirect depiction of their neighbor’s isolation and apparent depression:

“A person gets discouraged–and loses heart,” one considers…

“I stayed away because it weren’t cheerful–and that’s why I ought to have come,” says the other.

The two women express sympathy for the accused wife’s plight; they regret that they didn’t visit or otherwise help her earlier on, before the situation took a catastrophic, violent turn. The women understood, without saying it exactly. Mental health wasn’t a topic of common discourse, then, but these characters – and so must have the author, clearly – got the drift.

I won’t tell the whole story here, but I do recommend the tightly-woven, knotted piece.


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Blogging Addiction Disorder

The author has been concerned for a while that she might be addicted to blogging. Symptoms include wanting to post instead of working on a book proposal and other, likely more important projects. She was thinking of crowd-sourcing how best to describe this disposition, but it turns out the Internet already provides a diagnostic term:

Blogging Addiction Disorder, a.k.a. BAD, a possible variant of Internet Addiction Disorder.

That’s enough for today. (NTW, I’ll get back to work now.)

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The U-Shaped Curve of Happiness

This evening, when I finished cleaning up the kitchen after our family dinner, I glanced at the current issue of the Economist. The cover features this headline: the Joy of Growing Old (or why life begins at 46). It’s a light read, as this so-influential magazine goes, but nice to contemplate if you’re, say, 50 years old and wondering about the future.

The article’s thesis is this: Although as people move towards old age they lose things they treasure—vitality, mental sharpness and looks – they also gain what people spend their lives pursuing: happiness.

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