{Yachats, Oregon}
Still on vacation and giving my brain a chance to rest. Will be back to reality and blogging more extensively when I return from my break next week!
Hope you’re having a wonderful weekend!
{Lake Tahoe, California}
At the request of one of my awesome readers, I am writing a post on conquering our fears. Being an ENFP personality type (Extroverted, Intuitive, Feeling, Perceiving), I interpreted this in a more global, existential sense: getting over the fears and barriers that may interfere with moving forward in life and/or discovering one’s life purpose. However, others may be more interested in something more specific such as the treatment of specific phobias and social phobia, so I will be writing on conquering symptoms of those diagnoses in future posts next week.
Every psychotherapist has their own style, but the following are questions that I may ask my patients when it comes to conquering some of their biggest fears (if they can even put a name to what their biggest fears are because oftentimes, people are not even sure of what they’re afraid of):
1. Identify your fear. Once you’ve identified your biggest fear (ie, when it comes to a certain situation, such as pursuing a new job, finding love, etc), what is the very 1st thought that comes to mind if I was to ask you to close your eyes and think of the following question: When it comes to _______ (insert goal here), what is the one thing you are most afraid of??
Once aware of the biggest barrier/fear getting in the way of your goal, being consciously aware of this fear puts you more in control.
2. Origins of the fear. Where do you think this fear stems from? Have you experienced a similar, familiar sense of fear in your past or during your childhood?
Having a certain level of fear is normal because the reaction helps identify danger and take action to protect, but when the fear becomes excessive, there’s usually an origin to such fears based on past experience. Recognizing the connection with your past and how irrational the fear is in the present time can be enough for one to take action towards handling the fear more effectively this time around.
3. Take the next step. What small steps can be taken to slowly start working towards overcoming your fears?
For example, someone who is afraid of heights may start by going up to the roof of lower level buildings and working their way up to whatever their end goal might be to conquer the fear of heights (ie, skydiving, looking down while at the top of the empire state building, etc). Or, someone who is afraid of pursuing their dream career might start out by researching how to achieve the career, reach out to others to get advice, or start submitting applications to obtain the educational requirements or job experience needed to improve chances of getting their dream job.
4. Be open to disappointments and any challenges that come along the way. Fear of failure is a common barrier towards taking risks in life. Overcoming fears takes time and practice, so try to be as open as possible to learning and growing from the process. Surround yourself with those who support you in your goals and failures, and motivate you to stay on track. Wanting to give up is a normal feeling (I’ve experienced this numerous times, especially in the process of becoming a doctor) and NOT a sign of weakness.
But each time you get overwhelmed by the fear, ALWAYS REMEMBER and believe in yourself enough to recognize that you have a choice: either have power over your fears, or give power to your fears. So visualize the end goal, look your fear straight in the eye and say “f*** you, I’m the one in control” (yes, I’ve actually told some of my patients to say this).
{International Rose Test Garden, Portland, Oregon}
Okay, I’ll be honest. I’d much rather watch a documentary on Netflix (anyone have any suggestions?) and let my mind wander than write a blog post right now. Escaping to Oregon earlier this week for the first leg of my vacation provided a perfect combo of nostalgia, tranquility, and connection. Rather than psychoanalyze and process the impact that my trip had on my psyche (as I usually do in my posts), I’m instead going to reminisce and share pictures from my trip, which hopefully captures the essence of my time spent there. I still have one more week of vacation left, so if my writing doesn’t have as much structure and depth as usual, that’s because my writing is characteristic and reflective of my current, free-flowing state of mind.
{Washington Park, Portland, Oregon}
{Portland Japanese Garden}
{Yachats, Oregon}
{Devil’s Churn, Oregon}
Up until a few years ago when I graduated from residency, life appeared to have a linear, predictable path: obtain high school diploma, finish undergraduate degree, get accepted into medical school, graduate from residency, secure a well-paid job as a psychiatrist.
Yet, throughout the entire process, I encountered several challenging experiences trying to adjust to each new phase. When I moved away from home for college, I was so excited to live with four girlfriends and finally feel independent enough to lead an exciting college life. However, I can vividly recall the day my parents helped me move and when they left, I cried. For several days, all I wanted to do was isolate in my room. Eventually, I became more comfortable with my living situation and newfound independence, but my initial desire was to flee back home as often as possible.
For medical school, I was fortunate to get accepted into a school within 30 minutes from my hometown, so I was familiar with the area and lived with family that first year while adjusting to the grueling academic demands. It was so nice to come home to a hearty meal prepared by my grandmother or aunt after a full day of lectures, anatomy lab, and studying.
However, when I moved away to Oregon for residency (a state I never even visited let alone knew anybody who lived there), I felt extremely lonely and isolated. At some point, my program director suggested that I see a psychiatrist because I wasn’t performing very well on tests. I felt like a failure. Yet, finally realizing that I needed help was when I started to evaluate myself in order to create change. It’s the time that blogging became an outlet for social support and connection that I felt was missing at that point in time. It was the period of my life when I became more self-aware, made long-lasting friendships, discovered my leadership ability, and became chief resident. Such a pivotal point in my life motivated me to evaluate myself and discover my resiliency based on how I overcame my struggles.
When I rotated at the student psychological center at the local university, I saw several patients who struggled with transitioning to college life. I completely identified with them. I currently have several patients going through major changes (divorce, moving away for school, starting a new job, recently losing their job, getting married, expecting their first child, etc). I emphatically listen and validate their experiences — going through life change WILL challenge your usual ways of coping (ie, one may cope by isolating, keeping thoughts to themselves, working out at the gym more, confiding in a friend, etc). And sometimes, depending on the stressor, the usual copings skills may not be enough to overcome the challenge.
And here lies the dilemma — Even the most linear path in life has its challenges. Do you face the challenge head on, or do you recognize your limitations and choose a different path, or do you justify ways to avoid the situation altogether?
Photo by Marlon Santos
{Los Angeles, California}
I haven’t done a Thankful Thursday post on my blog in awhile (though I do a weekly “Thankful Thursdays” series on my Snapchat account), but figured I’d do one this week especially since my two week vacation is coming up the following week, which I’m long overdue and looking forward to. As I mentioned in one of my previous posts, I have been experiencing burnout from work, which has led to general feelings of detachment, mood changes, and decreased ability to efficiently maintain my responsibilities at work. Though my vacation isn’t until next week, I’ve been trying to relax and enjoy myself this week, which was accomplished by taking a spontaneous trip through Los Angeles, including the amazing Getty Museum. I am thankful not only for the break I’ll get, but for the fact that I recognized my need for self-care not only for the sake of myself, but also so that I can better support, care for, and be present for my patients.
Though of the Day: What are you thankful for from this week??
For background information of the reasoning behind my Thankful Thursdays posts, check out my 1st post of the series here! (And subsequent posts here and here).
{Santa Monica sunset}
{Malibu, California}
I recall previous 4th of July holidays spent working in the hospital, or on-call with my pager held tight as I nibbled on barbecue anxiously anticipating a flurry of calls regarding the behavioral management of alcohol-intoxicated patients. This year, however, I am free from the responsibility of being on call, free from the hospital, free from clinic, but NOT free from the mentality that I SHOULD be productive and get items A-Z done on my to-do list. Doctors tend to be perfectionists, overly self-critical, driven, competitive, which usually means that putting their “workaholic” tendencies aside in order to relax can be quite difficult. Well, at least that’s how I feel, but I’m working on it.
So, today after 12pm I intend on putting my computer, to-do list, and anything work-related aside for the sake of my own health and sanity. I think it’s about time to enjoy the traditions of this historic event in America, especially since barbecue and the beach sound far more appealing than doing paperwork and organizing my house.
Thought of the Day: Any other workaholics with me on this? Do you allow yourself to put work aside during holiday weekends?
I attend pharmaceutical dinners every once in awhile because: 1) I like to stay up to date with all the new drugs (or just a slightly modified version of the generic, but with a much fancier name and packaging); 2) Though I’m several years out of med school/residency, one thing I have maintained from those formative years is the mentality where I’d never pass up a free meal. I know that pharmaceutical sales representatives (also known as drug reps) have been banned and limited in several institutions, and I completely understand the reasoning (it has been shown that drug reps’ marketing tactics influence physicians to write prescriptions they typically would not write, thus boosting pharmaceutical sales). However, I also think it’s important for physicians to be self-aware of their existence and influence in order to make conscious decisions on their own.
A few months ago, I attended a pharmaceutical dinner sponsored by the manufacturer of one of the newest psychiatric medications. These dinners always feature a physician, who describes the medication (the pharmacology, indications, side effects, etc), explains the existing research in support of the medication, and leads a discussion and answers clinical questions. My initial impression of the night’s presenting physician: charming, and since his introduction boasts the research he conducts at a prestigious university, he must be highly reputable and intelligent. But, as his talk progressed, I realized how narcissistic and full of sh** he was. I sat in the very front, yet chuckled to myself and assumed every other clinician in this room picked up on his suave, yet unconvincing tactics. I mean, who was this guy trying to fool by flaunting his European accent and stories of trips around the world??
However, I looked around the room and the entire audience of doctors and other clinicians were laughing and smiling in awe. I tried to hide my disdain and cringing facial expressions, but I sat at the very front of the room, so I’m sure others noticed. Or maybe not…I mean, everyone in the room was mesmerized by this guy! I figured that I should refocus my thoughts and give him another chance and caught up just in time to hear about his trip to Europe. I shook my head and thought to myself, “wow, can you believe this guy? And he gets paid tons of money to attend this dinner and talk about himself?” I smirked and assumed his current, pointless story-telling (aren’t we supposed to be discussing the medication?) would be convincing enough to prove his bullsh**, fake persona, so I turned to look at the audience assuming others would catch on. Still, all smiles.
At the end of the dinner, I found myself in a dilemma as I had to pass this man on my way out as I left the dining room. I contemplated whether I should act just as fake as his schmoozing and say something along the lines of “hey, great presentation” or should I challenge some of the comments he made? I settled for a more neutral comment and told him “thanks, you are very entertaining” as I shook his hand and smiled.
Then, I realized at that very moment I became just like everyone else in the audience who commended and complimented him. For a temporary, quick second I even contemplated prescribing the medication. The thought of prescribing the medication was short-lived, for, after I left the restaurant, I snapped out of it and wished I gave him a piece of my mind.
I thought, “oh well, instead I’ll just stick with my guns and won’t be overly influenced to prescribe the med, unless clinically indicated.” (I’d never deprive my patients of a medication that might possibly help). I now realize even more why pharmaceutical companies used to frequently provide fancy trips, extravagant dinners, and expensive novelties before policies/rules became more stringent. The speakers and drug reps can be quite hypnotic and mesmerizing, but it’s our duty not to be fooled by any marketing tactics.
Or have I already been swayed?
{Napa, California}
I am so appreciative of the supportive comments I received after sharing my personal experience of physician burnout. I’ve had similar experiences, especially during medical school and residency, but never felt comfortable enough to share until recently. In my practice, I work with so many patients who suppress their emotions. I identify with them wholeheartedly because I am just like them. During residency, I made excuses to avoid meetings with my supervisors because rather than discuss patient cases, the meetings would somehow turn into therapy sessions where I’d cry and feel embarrassed for exposing my vulnerabilities. At the time, suppression and isolation were the only ways I knew how to cope, but it’s a pattern I am actively trying to break ever since I started seeing a psychotherapist during my fourth year of residency.
A common phrase that I mention to my patients (which was told to me by my amazing sister, who is a marriage and family therapist) is that “if you suppress yourself, you depress yourself.” We all suppress ourselves to some degree, but once able to overcome the barriers {our own internal barriers (i.e. cultural, self-criticism, etc), in addition to external barriers (such as the immense pressures and expectations placed on physicians)}, then we have a better chance at achieving wellness and exerting more control in our lives and our careers.
{Calistoga, California}
I noticed that my latest posts convey far less emotion than usual. My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip. Perhaps I should have requested two weeks off instead of one? Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day. At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep). I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache. Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?
Fatigue continued to hit me on a daily basis. And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case. However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression. One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”
I thought to myself, “How can I be depressed? I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”
Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed. I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day. How dumb of me not recognize the signs, especially since I’m a psychiatrist??? (Depression obviously impacts cognitive abilities as well)
Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time. He missed his last two appointments with me and never returned follow-up calls. I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name. Tears filled my eyes, which led to uncontrollable sobbing. I seriously wanted to quit my job that very moment.
My attempt at self-care and setting healthy boundaries:
Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others. I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient. I allowed myself to cry rather than holding in the tears.
Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder. I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again. Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.
Why am I sharing my experience? We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame. A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share? Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.
Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise. If we can’t advocate and stand up for ourselves, then who will?
{Miami Beach, Florida}
Lately, my ability to write and stay connected via my blog and social media requires far more effort than usual. I’ve written in previous posts that when life gets overwhelming, one of the first things that fall to the wayside is my blog. I’m trying hard to stay consistent on posting because the last time I put my blog aside, I ended up taking a one year hiatus from September 2013 through September 2014. I sound like a broken record when I find myself regularly struggling with life balance, though I’m well aware that the ability to find balance is an ongoing process.
This weekend, I’m headed to northern California to visit my family for Father’s Day and am looking forward to reconnecting again. I also have group therapy today before catching my flight, so i hope to get some feedback from my therapist and group members regarding my disconnect and self-critical self.
I know that I am human, “nobody’s perfect,” and we’re entitled to our good and bad days. Yet, I just can’t help getting frustrated when I don’t feel like myself. I’m sure several of you out there can relate?