Category:

Lifestyle

A Psychiatrist’s Tips To Survive Summer Music Festivals

{Coachella in Indio, California}

I’ve been to my fair share of music festivals and several of my patients feel comfortable enough to tell me when they’re attending festivals as well. As fun as music festivals can be, they can also be exhausting, so some may return home feeling physically ill (I admit that I caught the flu after Coachella this year). And though strict policies exist regarding illicit drugs, they still make their way on to festival grounds, and some may experience longer lasting neuropsychiatric symptoms as a result of substance use during these events.

Since we’re in the midst of summer music festival season, the following are my tips on surviving music festivals with your health (and mind) as intact as possible:

Prioritize Sleep & Rest. Music festivals are like a marathon (the typical music festival occurs over one weekend, from Friday to Sunday), so conserve your energy and plan for breaks and naps when needed. You’ll likely return to your accommodations (camp, hotel, house, etc) pretty late (or super early in the morning), so make sure you get enough rest before heading back to the festival grounds. More power to you if your goal is to party all day & night, but chances are you won’t have the energy to make it through the entire festival.

Stay Connected. Most people travel in groups, so minimize the stress of losing track of each other by doing the following:

Set up a group chat (use apps, such as WhatsApp or Facebook Messenger, since cell phone reception might be spotty).
Time stamp your text messages — there’s nothing worse than receiving a delayed text (and not knowing it was delayed because there was no time stamp!).
Set a meeting place as a designated spot if you and your crew can’t find each other.

Know where the medical tent is. I know several colleagues who have worked at medical tents for Coachella and they’ve seen it all — from dehydration to intoxication. Each music festival should have a medical staff stationed there, so even if you don’t know where they’re located, at least know that medical services are available if needed.

Stay hydrated. With high temps during the summer combined with a lot of dancing, walking, and possible use of alcohol or drugs that may exacerbate dehydration, it’s important to make sure that you have plenty of water on hand.

Use your best judgment when it comes to drugs and alcohol. Medically, I’d like to say “don’t drink or use drugs,” but the advice of “just say no” has long been proven to be ineffective. And also, I don’t live under a rock — I know that illicit drugs get used at these festivals. So, what I will offer here is my hope that you will use your best judgment, in addition to considering the risk of long-term neuropsychiatric effects that may occur from use of certain substances, especially the commonly used MDMA (ecstasy, Molly, etc). Due to the massive serotonin release of this drug, tolerance develops quickly, and prolonged use can lead to permanent damage to serotonergic mechanisms in the brain. I’ve treated patients with panic attacks, generalized anxiety, depression, memory impairment, insomnia, and other sequelae that have persisted even after stopping use of this drug.

What to pack. Don’t be fooled by social media and assume that everyone dresses in picture perfect outfits and walks around in heels during these festivals (I made this mistake and wore heels to my first festival — worst mistake ever). Comfort should be a priority when it comes to deciding what to wear and what to bring. Aside from clothing, here’s a list of other important items to consider packing:

Comfy shoes
Hat
Sunblock
Portal phone charger
Bandana (to cover face in dusty environments since most festivals are in fields)
Long sleeve or light sweater/jacket when it gets colder at night

And last, but not least — my last tip is to let go of any pressures you have to undergo the ‘perfect’ experience because that mentality just adds unnecessary stress. In my experience, once I let go of trying to look ‘picture perfect’ (not every outfit has to be Instagram-worthy) and do ‘everything’ during the festival, I was able to focus on being present, enjoying the music, and having a fun & memorable time.

June 14, 2017 6 comments

Lifestyle Medicine

A Psychiatrist’s Perspective of Time

written by freudandfashion

As a psychiatrist, time dictates my day in the office. My schedule is divided into 20-minute increments for patient follow-up visits and 40-minute blocks for new patient evaluations. I try my best to stay within the specific time limits, but sometimes patients require a bit more time in order to effectively convey & discuss the diagnosis and treatment plan. If a few minutes overtime are needed, I allow it, however, it’s also necessary for a psychiatrist to set boundaries on time because it can take away from each successive patient’s appointment time. Even though some patients may take up more time than allowed, it’s my job as a psychiatrist to direct the interview and complete the entire session within a reasonable timeframe.

Sometimes patients are so anxious about disclosing information that they wait until the last minute when the session is almost over. A psychiatrist should acknowledge the patient’s disclosure and triage/judge whether or not the issue is emergent and must be addressed, or if the issue can wait until the next appointment. I’ve had to remain in the office after hours several times, mostly when a patient is an imminent risk and needs to be assessed for possible hospitalization.

If you don’t feel like you get enough time with your doctor, then you’re not alone. Most doctors wish they could spend more time with their patients, but the pressures to see a patient within a short amount of time exists. Over the past four years that I’ve been in practice, I’ve developed my own therapeutic style that allows me to to efficiently ask necessary questions while maintaining a connection with my patients (hint: such techniques involve direct eye contact, spending the first few minutes allowing the patient to talk uninterrupted, acknowledging factors in their lives other than solely discussing meds, etc). In a 20-minute session, I probably average spending 25% of the time discussing medications. A psychiatrist’s job isn’t easy — I may be a physician, but I’m also a human being and can’t help but be impacted by my patient’s heartbreaking issues. Therefore, prioritizing time for self-care is absolutely necessary.

I utilize my weekends doing non-psychiatry activities (with the exception of blogging & social media). I used to be on-call at my previous job, but realized I needed weekends off to maintain my sanity. I admire anybody who takes call on weekends, but for me there was nothing worse than getting paged at 2 am and driving to the hospital half asleep.

Having made career decisions that doesn’t compromise on providing the best quality of care I can nor the people and activities that are important to me, I feel much more balanced with my current part-time schedule. I used to feel extremely constrained by time (I still feel that way, but not nearly as much), but these days I am far more in control of how I choose to spend it.

Watch: c/o JORD (For the link to my watch, click here)

August 26, 2016 9 comments

Lifestyle Medicine

Say ‘No’ To Burnout: A Renewed Physician’s Goal for 2016

written by freudandfashion

{Napa, California}

2015 was a year to regroup and reassess my professional goals. Immediately after residency, I did as most physicians do — apply and hope to get a job that pays well and is in a good location. Similar to the personalities of most physicians, I am a workaholic and overachiever. Therefore, since graduating residency, I strove to perform well at my job, treated my patients to the best of my ability, passed my psychiatry board exams, in addition to participating in extra professional activities on the side (gave psychiatry talks, restarted blogging again, enrolled in a psychoanalytic course, etc) while attempting to balance my personal life. However, after the first two years as a practicing physician, I became disillusioned by the sad reality of our broken healthcare system.

When I first started working, I was an enthusiastic, energetic psychiatrist ready to use all the knowledge and expertise I acquired in my training to make an impact and help improve the lives of many. But, then I recognized my limitations. I noticed that the pressures exerted by the system to deliver cost-effective care, see a high volume of patients, and obtain exemplary patient satisfaction scores while maintaining my ideal ways of practicing, were nearly impossible to sustain. I noticed a decline in my ability to balance life outside of work and took my frustrations out on those around me. I participated in psychotherapy, group therapy, exercised, went to church, ate a healthy diet — basically, did everything that you’re “supposed” to do to manage stress. It may have helped for one day, but then I still dreaded waking up the next morning to go to work. And once I noticed a decline in my passion for practicing Psychiatry, I knew that such a decline in my quality of life was NOT the type of life I deserved after busting my ass throughout college, medical school, internship, and residency. I deserved to be happy. I deserved my ideal practice.

I have written posts about my personal experience with burnout, have read numerous articles about physician burnout, yet still struggle to fully describe how debilitating the experience is because it evokes a sense of failure, a “system malfunction” of everything we were programmed to do since day one of medical school. This article by Dr. Dike Drummond most precisely describes the factors that lead to physician burnout. As much as I would like to do so, I cannot fully fault my employer because I understand their methods from a business perspective. In order for the organization to thrive, physicians are key components to meet the organizational goals. And we allow it. We adjust. Most of us don’t know any better. Medical school doesn’t teach us to be business savvy, nor how to market ourselves, nor give us the tools needed should we decide to venture out on our own to create our own practice. And most notably, we are not taught how to prioritize self-care nor how to advocate for ourselves when stressed and overwhelmed. Often such behaviors of speaking up for one’s self are viewed as weaknesses. To this day, I still have the mentality that I’d need to be on my deathbed in order to miss a shift out of fear of being perceived as less than superhuman by my Attendings and peers.

Initially, I blamed myself for not being able to keep up with the heavy workload and for feeling so defeated. But then I realized that I had a choice: either 1) Quit and seek my ideal practice, or 2) Adjust to the system and forego any sense of autonomy and watch my passion to make an impact in the field of Psychiatry further dwindle away.

I quit and spent 2015 working a reduced schedule and essentially recovering from my entire medical career thus far. Throughout the process, I had to re-train my mind to let go of the standards that were ingrained since medical school: the need to be a workaholic, the need to be a genius and know everything (otherwise risk being ridiculed), the need to be superhuman, the need to suppress and hide my struggles, the need to be a perfectionist at all times, the need to function at 110% amidst exhaustion and fatigue.

A patient doesn’t benefit from a burned out physician (in fact, it has been shown to lead to greater medical errors). And if a fellow physician is struggling to maintain, we must not consider them as weak. Please understand that they deserve just as much care and attention because they sacrifice their own well-being for the sole purpose of providing care to others.

I will never forget one regretful time that I was on-call: already worn out from the day’s clinic, I angrily dialed the number on my pager and spoke to another physician on the other line, who paged in hopes of getting advice to help a fellow physician struggling with suicidal thoughts. My reflex response was uncharacteristic of me, lacked empathy, and to this day makes me cry with regret:

“I’m sorry, but I can’t help you. Tell him to go to the ER.”

I would never even fathom giving such an insensitive response to one of my patients. Just knowing that I turned my back on one of our own…someone who very well could’ve been me had I stayed and felt trapped in my job…someone who represents the growing number of depressed and suicidal physicians, makes me sick with disgust. I vowed to never again lose myself so much in a job that I risk losing my empathy and compassion. However, as I type this, I recognize that as much as I blamed myself, I see how that “programming” from medical school, which taught us that any sign of struggle represents weakness, overrode my empathy.

Therefore, my goal for 2016 is simple: to maintain balance. For the first time in my life, I feel deserving of breaks and time off, feel open to share my struggles (and view them as signs of strength, not weakness), and feel confident in who I am as a physician deserving of a practice that supports my lifestyle (rather than one that consumes me).

And one last note: I’ve observed the new class of aspiring doctors, have connected with them via social media, have met with the shining future leaders of our future healthcare system — and they are a population unafraid to support one another and voice their needs. They are students who are starting to open up about their desire for self-care and balance. They are students who are championing wellness programs in their medical schools. They are students who are tech savvy and understand marketing tactics (because they have the tenacity to reach their own international following that closely watches and looks up to them as they develop as authentic role models on social media). They will detect the bullshit of organizational “wellness” programs and any false attempts at showing they are being “cared for,” when in reality they are being appeased only long enough until thrown back into the same working environment that led to their decline…and the cycle continues. Although most posts on physician burnout are pessimistic about the potential for change, with what I’ve observed, I have even more hope that our future doctors will come together and do what they can to put a stop to the cycle.

Photo by Alex Manipod

January 8, 2016 38 comments

Lifestyle Psychiatry

New Year’s Resolution Ideas To Enhance Your Mental Health

written by freudandfashion

Not sure about you, but I got tired of writing down the standard New Year’s resolutions on my list (such as losing weight, making more money, etc) several years ago. Research has shown that people typically lose momentum to carry out their resolutions within the first 6 months, so why not make a list that enhances your life and contributes to happiness for the long run rather than relying on a number (ie, pounds lost, money earned, etc) to determine whether or not you succeed?

Achieving your resolution is a process…it has ups and downs…successes and failures. If we learned to embrace the process, we’d likely maintain momentum (ie, “okay so I ate a lot of chocolate and pastries on Valentine’s day — I’m going for a run the next day,” rather than the negative self-talk such as “I’m such a fatty and a failure because I ate a piece of chocolate”). I say, get over it and move on — after all, you’re human. You either have the option of stressing and obsessing about that one piece of chocolate (thus increasing your cortisol levels leading to increased fat storage) or owning up to eating that piece of chocolate and viewing it as fuel for your workout or a well-deserved treat. Perhaps self-love and forgiveness can also be a resolution? Since awareness of the importance of mental health has been gaining more traction lately, let’s make 2016 a year to focus on your overall mental health and well-being.

The following are some ideas that I share with my patients on a regular basis, in addition to some resolutions that I plan to incorporate into my own list for 2016:

1. Improve your sleep patterns. I listed this as #1 because it’s actually at the top of my own list since I stay up way too late despite having to wake up early in the morning for work. Sleep is correlated with your health (insomnia is related to hypertension while too much or too little sleep increases the risk of stroke, for example), levels of concentration, and mood. So how much sleep do you need? You can check out the National Sleep Foundation’s recommendations for amount of sleep here.

2. Substitute some of your least healthy food habits with more nutritious options. It has been shown that those with better quality diets were less likely to be depressed and people who eat higher amounts of processed food was associated with increased anxiety. Here are a couple of substitution ideas:

Instead of soda: try flavored sparkling water, fruit-infused water, unsweetened iced tea. (This is how I quit drinking soda about 4 years ago)
If you eat fast food on a regular basis, aim for an option that perhaps is charbroiled instead of fried (ie, grilled chicken sandwich instead of battered).
If you want to fulfill the craving for fried food, be sure to use oil from healthier sources (ie, coconut, olive, and grapeseed oil).
Instead of snacking on white or milk chocolate, switch to dark chocolate.

3. Make more of an effort to connect with others. This can be as simple as smiling or saying “hi” to people that you walk by on the street to making more of an effort to talk to a co-worker whom you normally don’t speak to, or re-connecting with an estranged family member. Social interactions with those you are close to, in addition to acquaintances, are linked to a greater sense of belonging and happiness.

4. Give back by volunteering. Volunteer work increases social connectedness and has been shown to lower levels of depression, especially for people over age 65.

5. Discover the exercise/sport/gym/physical activity that you love so much it becomes part of your regular routine rather than a chore/hassle. Rather than committing to losing weight, why not first find the physical activity you enjoy and desire to participate on a regular basis? Then, the benefit of engaging in the activity leads to getting in better shape. It’s really all a matter of perspective. If you focus on a specific number of weight to lose, then you’re more focused on the end outcome (and that could entail unhealthy habits such as yo-yo dieting, starving yourself to meet that number, or overexerting yourself at the gym — basically, methods that are unsustainable and add excess stress to your body).

6. Take up a new hobby. In effort to live a more balanced life, having a hobby can be a healthy distraction away from your everyday stressors. I’ve been meaning to improve my golf skills ever since I first played a round during residency several years ago (okay, maybe I didn’t play all 18 holes, but still). I’ve already bookmarked a few golf courses to check out and plan to go to the driving range in January. Anyone care to join?

7. Spend less time on your smartphone/social media and more time engaging in real conversation (and life in general). Americans have been found to spend an average of 4.7 hours/day on their smartphones. This is going on my list as well because I’m definitely on my phone way more than I should be. Although social media can be a great source of support to connect over mental health issues, it has also been linked to insomnia and increased anxiety in the teenage population. I believe that adults are likely also impacted by social media in a similar manner, so reminding ourselves to unplug more can lead to less distraction and greater productivity to accomplish the other resolutions on your list.

Photo by Marlon Santos

December 29, 2015 26 comments

Lifestyle Medicine

Thankful Thursdays

written by freudandfashion

{Venice Beach, California}

For this week’s Thankful Thursdays, I would say that I am very thankful for one of my best friends from medical school, who flew into town for a quick visit. My resolution for the remainder of the year (mentioned in my previous post) included being spontaneous and free to explore. Surprisingly, in all my years living in southern California, I have never experienced biking along the beaches of Santa Monica and Venice, nor have I ever gone shopping on Abbott Kinney (a well-known boulevard located in Venice lined with trendy/urban shops, earthy/cool restaurants, and more). We had a wonderful time catching up, eating delicious food, and discovering new fixtures in the area that we’d never noticed before. I figure that Los Angeles still has a LOT to explore, therefore, to kick off my resolution, I might as well begin locally!

Thought 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, here, and here).

August 20, 2015 8 comments

Lifestyle

Personal Independence Day

written by freudandfashion

{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?

July 4, 2015 9 comments

Lifestyle

Much Needed

written by freudandfashion

{Miami, Florida}

I’m constantly testing my limits as to how long I can continue working before I become extremely stressed-out and less pleasant to be around, which usually indicates I’m overdue for a vacation. When I scheduled my vacation months ago, I had a feeling I’d be overexerting myself having too large of a time gap in between breaks. Well, I definitely learned my lesson this time around (yet again). Part of self-awareness and good self-care is recognizing when you’re in need of a break. Therefore, for the next ten days, I’ll be catching up with some much needed sleep, laying out on the beach, and doing nothing work-related. Next week I plan to head to Miami, which is the city I fondly remember as providing the most fun during my medical school elective rotations. Actually, I do have one task: learning how to use Snapchat and hopefully posting snaps during my vacation (if you’re on Snapchat, add me @freudandfashion and follow me on my journey towards wellness, balance, and self-care!).

Have a wonderful weekend!

May 30, 2015 14 comments

Lifestyle Personal

Finding Balance

written by freudandfashion

{McDowell Sonoran Preserve, Scottsdale, AZ}

During my stay in Arizona, I was fortunate to reunite with friends from my residency training program and was especially excited to spend time with one of my closest friends from medical school. One of the subjects we talked about most was the struggle to obtain or achieve work/life balance. Balance and avoidance of burnout is essential for overall emotional and physical health. Burnout has been shown to be more prevalent in medical students, residents, and early career physicians compared to the general U.S. population.

My life is much more balanced than it has ever been, and I believe the biggest barrier towards accomplishing this in the past was the perceived lack of time as an undergrad, medical student, and psychiatry resident. I emphasize the word perceived because I truly believed that sacrificing my personal life for the sake of my future career was well worth the burnout. Well, by choosing to become a physician, yes, an immense degree of sacrifice is required. If I failed at any point in the process, would I have been upset? Hell yes! And I actually did almost fail because I put so much pressure on myself to do well that my anxiety sky-rocketed and impacted my test-taking abilities. Therefore, my scores were in no way reflective of the amount of time I spent studying, which really sucked (no need for a more formal term for my emotion; “sucked” pretty much sums it up). At that point, I broke down, cried, and told my parents that I wanted to quit medical school. And it wasn’t until then that I realized they didn’t care which profession I chose — they just wanted me to be happy. What a huge relief! All this time I thought I’d dishonor my traditional Asian family if I didn’t become a physician. Suddenly, at that moment, the weight and pressure to please my family lifted. I felt liberated. However, the remaining pressure I possessed was the pressure I placed on myself because I didn’t know of any other way to approach life while working towards my medical degree.

Looking back, if I had the opportunity to offer my past medical school self any advice, I’d tell her the following:

To sacrifice a few hours of studying a week in order to instead go out and do something enjoyable to enhance personal growth and interests.
To be less self-critical. Little does she know that she’ll be just fine if she doesn’t graduate from the most prestigious, academic medical school or get accepted into the most renowned residency program.
Just try your best and don’t beat yourself up in the process. After all, one of the top 5 things people regret most on their deathbed is “I wish I hadn’t worked so hard.” I definitely know that I’d never say I regret not working or studying more. Simple activities, such as enjoying nature and going on hikes, are far more memorable in my mind compared to the insomnia I experienced trying to squeeze in last-minute studying for a histology exam.

March 17, 2015 7 comments

Lifestyle Personal

Thankful Thursdays – Time Off

written by freudandfashion

{Fairfield, California}

Time off from work couldn’t have arrived at a better time. It has been awhile since I wrote my last “Thankful Thursdays” post (see previous ones here and here), so I think it’s appropriate to write one given my current state of mind (which is more relaxed and centered). My vacation started off with a quick, last minute trip to visit my family in northern California, which is usually my preferred travel destination each time I get the urge to feel more rooted and have the need to reset. During a stroll with my sister, I realized the grassy hilltops are gorgeous landscapes that I’ve taken for granted ever since my family first moved to the area when I was in junior high. For some reason, the lush hills appeared immaculate and majestic this time around. I enjoyed reuniting with family visiting from the Philippines, tasting my mom’s traditional filipino dishes, and playing card games with my cousins and siblings. I truly savored my brief stay.

Currently, I am sitting in a hotel lobby located in the flourishing city of Scottsdale, Arizona. I stare outside at the backdrop of pristine mountains, pale blue skies streaked with thinly layered clouds, and adobe fountains and fixtures at the forefront. Everything seems extremely tangible – from the texture of the furniture to the warmth of the sun hitting my face. While attending a conference, I am also aware of the numerous psychiatry and neurology residents here preparing to take their board exams tomorrow, as they lay out by the pool with heads buried in flashcards and exam prep books.

“I remember being in your same position two years ago,” I said to one of the girls who studied while lounging on the chair next to me. All I could remember from that day two years ago was memorizing the diagnostic criteria for various psychiatric diagnoses, the treatment for alcohol and drug withdrawal, etc. I never would have imagined noticing the simplistic, yet characteristic details of the locale like I am able to observe now. Fortunately, I passed the horrific test, yet I reflect on the past and a part of me wishes I was more mindful of the details from that experience. However, as the saying goes, “better late than never.”

Photo by Marlon Santos

March 12, 2015 6 comments

Lifestyle

Casual Fridays

written by freudandfashion

{Scripps College, Claremont, CA}

To lighten up the mood, I decided to create a series that highlights a bit more about my lifestyle as a busy physician, in addition to specific interests related to fitness, fashion, food, and travel. When I first started my blog during residency, my original goal was to create a lifestyle blog, however, my schedule at the time consisted mostly of work and studying, so my nerdy lifestyle wasn’t too exciting! Over the years my blog has evolved to focus on inspiring, creating, and maintaining a lifestyle geared towards the promotion of mental health. I believe that providing a forum to share information on activities and items that we use to enhance such a lifestyle can be beneficial.

My first post of the “Casual Fridays” series is about shopping and methods I use to save time as a busy professional. When I lived in southern California, I seriously lived across the street from a shopping mall, but when I moved to Oregon for residency training, the closest mall was over an hour away (this might seem frivolous, but not if you’re a so-cal girl)! Therefore, online shopping became my best friend. One important item I’ve been lagging to buy are a new pair of prescription lenses, basically because I’m often exhausted after work or don’t like the hassle of going to busy shopping centers on weekends, so I keep putting off going to the store. When I came across Warby Parker, I felt relieved to find out they have a home try-on program, which meant not having to deal with LA traffic (definite bonus points). Customers select 5 pairs of prescription eyeglasses from their website and they are mailed to you shortly after, then you attach the pre-paid shipping label to send them back after 5 days, all at no cost. The whole process is simple and straight-forward, which I especially appreciate. Since I tend to lose track of time and dates, I had to call their customer service number to confirm my return date and the representative on the line was helpful and friendly. Below are the 5 styles I chose:

I have a tendency to go with simple monotone frames, so this time I’d like to be a bit more adventurous. I’m considering the Finch design from their Spring 2015 Collection (worn in photo at the very top and below). Before I commit and order them online, I’d love your opinion…Yay or Nay?

Photos by Marlon (Veils & Vows)

February 20, 2015 22 comments