Category:

Medicine

How Anxiety And Depression Can Affect Quality-of-Life in Endometriosis Patients

written by admin

Since March is Endometriosis Awareness Month, I’m excited that Dr. Tosin Odunsi-Akanji (Instagram: @lifebytosin), one of my fave physicians to follow on social media, took time out of her busy schedule to write a post to increase awareness of how the diagnosis can impact not only physical health, but also mental health.

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Imagine dreading a specific time of the month every month for 14 years. Imagine feeling like you’re being stabbed by hundreds of knives. That was me every time my time of the month paid me a visit. If I was able to, I would spend the first couple days in bed armed with ibuprofen and a heating pad. After a gastrointestinal workup in college came back normal, I figured the pain was normal and must be the cramps women complained about.

Eventually, I said something to my gynecologist and was placed on birth control pills without an interrogation of the pain. This helped bring the intensity of my chronic pain down from an 8/10 to a 4/10. I was more than okay with that. Fast forward to my third year of medical school when I was studying for my USMLE Step 2 Board Exam. One of the practice questions asked for a complication of endometriosis. The answer was ‘infertility.’ I immediately started crying because by this time I suspected this was what I had and I thought I would end up infertile. Soon after that, I was awakened from sleep with severe abdominal pain. I ended up having surgery and finally received a diagnosis of endometriosis.

What is endometriosis? It is a chronic disorder in which the tissue that forms the lining of the uterus (the endometrium) is found outside the uterus where it does not belong. These implants respond to changes in estrogen and may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen which can cause severe pain throughout the month. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

The most common clinical signs of endometriosis are menstrual irregularities, chronic pelvic pain (CPP), painful periods, painful intercourse, and infertility. Symptoms of endometriosis often affect psychological and social functioning of patients. For this reason, endometriosis can be considered as a disabling condition that may significantly interfere with social relationships, sexuality, and mental health. If this is the case, then an important area to consider is the impact of anxiety and depression on the management of women with endometriosis.

Several studies have been conducted to showcase the influence of CPP on psychological well-being and quality of life of women with endometriosis. Women with endometriosis have a higher risk of developing anxiety, depression, and other psychological symptoms, according to a review study published in the International Journal of Women’s Health. Data suggests that the experience of pelvic pain may significantly affect emotive functioning of affected women. Furthermore, high levels of anxiety and depression can amplify the severity of pain. Additional studies are needed to better understand the relationship between psychological factors and perception of pain.

Treatment of endometriosis may be hormonal or surgical. Surgery is the primary treatment for severe forms of endometriosis. There is not much data in the literature about the influence of psychological factors and psychiatric co-morbidities on the effectiveness of treatments. It is important to evaluate the presence of previous psychiatric diseases in order to select the most appropriate treatment for these patients.

Endometriosis affects roughly 10% of women of reproductive age. On average, endometriosis can take six to ten years to diagnose and three out of five women with endometriosis were told by at least one doctor that nothing was wrong. In my own experience with endometriosis, I did not have an answer for what was causing my pain for 14 years. It is not surprising that part of my life revolved around my menstrual cycle. March is Endometriosis Awareness Month. Perhaps more attention can be paid to women who have psychiatric complaints in addition to CPP in order to better tailor treatment.

For more on Dr. Tosin Odunsi-Akanji, MD, MPH, you can find her on YouTube and Instagram.

References:

The American College of Obstetricians and Gynecologists. Frequently Asked Questions.

https://www.acog.org/-/media/For-Patients/faq013.pdf?dmc=1&ts=20180320T1527594194

Anxiety and Depression in Patients with Endometriosis: Impact and Management Challenges

https://www.dovepress.com/anxiety-and-depression-in-patients-with-endometriosis-impact-and-manag-peer-reviewed-fulltext-article-IJWH

SpeakEndo

https://www.speakendo.com

March 30, 2018 0 comment

Fashion Medicine

Intern Year Memories in Smitten Scrubs

written by freudandfashion

{Smitten Bliss Scrubs c/o Smitten Scrubs via Scrub Shopper}

The last time that I wore a pair of scrubs was several years ago as an intern physician doing internal medicine. And they were the standard pale blue hospital scrubs that you practically live in as an intern rotating through the hospital wards as part of the internal medicine, family medicine, general surgery, emergency medicine, and ob/gyn teams. I recall running up and down the hospital stairs in them, zipping through the emergency medicine floor in them, and getting various bodily fluids splattered onto them despite my best obsessive-compulsive attempts to keep them clean. Then, the routine was to fall asleep on the couch in my scrubs within seconds upon returning home from a 30-hour shift. Hence, scrubs have provided me with memories both exhausting and accomplishing.

As a psychiatrist, I no longer wear scrubs, though I miss the ease of getting up in the morning without having to dedicate minutes contemplating what to wear to work. Therefore, when Scrub Shopper reached out to me to promote the relaunch of one of their brand lines, Smitten Bliss, I was excited to wear and experience the new generation of scrub designs and styles.

The following is my opinion regarding the Smitten Bliss line scrubs that I received:

Warmth – I was out running errands on a cold, chilly, yet crisp day in so-cal. These scrubs kept me pretty warm and I was able to wear them without having to wear layers underneath nor a jacket over it.
Comfort – the scrubs are made with polyester & spandex and provide enough stretch to allow ease of movement.
Style – these scrubs are far more stylish than the standard hospital scrubs! The material is of high quality. They come in a variety of colors (berry, heather grey, royal blue). The ones I’m wearing are in navy. I also love the pink trim, which adds a pop of color.
Sizing – I love that the pants come in petite sizes (which is perfect since I’m 5’2”). The top in size small was slightly longer in length than I prefer, but I’m sure would be perfect for those taller than me.
Functionality – The pants and top have several pockets, which are much needed while on the job.

And what I really like about Scrub Shopper is their Give Back campaign in which Scrub Shopper offers donations to Susan G Komen, Doctors Without Borders, St. Jude’s, the Abandoned Pet Project, and the Greta James Scholarship Foundation. Customers will have the option at checkout to choose one of those options, and they will donate $1 per order to the organization of their choice.

And as an added bonus, Scrub Shopper and I have collaborated to host a GIVEAWAY for one of my followers on Instagram to receive a free pair of Smitten Bliss scrubs! Check out my link here for simple rules on how to participate!

Do you wear scrubs to work?? And if so, what is the most important factor about the type of scrubs you choose (cost, style, pockets, color, etc)??

March 1, 2017 7 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

Medicine

How I Connect With Our Future Doctors

written by freudandfashion

Latino Medical Student Association National Conference 2016

I realize it has been a few weeks since my last blogpost and the reason is because I have been even busier since receiving wonderful opportunities to speak at conferences. Blogging and being active on social media has provided an amazing outlet to share my views on mental health, yet speaking at conferences would also be a great way to directly connect with our future doctors and health care professionals. I’m pretty open on my blog about my previous struggles with social anxiety, so although public speaking can be challenging and highly anxiety-provoking, it has been one of my best methods for overcoming my anxiety.

The video above is a quick edit of my participation as a speaker for the Latino Medical Student Association’s National Conference, which was held at my medical school, Western University of Health Sciences College of Osteopathic Medicine of the Pacific. I hosted a workshop on ‘medical student burnout’ and was also a panelist for the Women In Medicine panel. Speaking at my medical school was a reminder of how I’ve come full circle as a former struggling medical student and returning as a physician sharing my knowledge and experiences!

Video by Marlon Santos

April 26, 2016 5 comments

Medicine

Healthcare Lesson On a Plane Ride

written by freudandfashion

{Sacramento International Airport}

On my flight from Austin (where I spoke at the SNMA conference) to Sacramento last week, I sat next to a kind, wise man in his 80s who explained his history of diabetes as he pulled out his glucose meter to check his blood sugar. “I hope you don’t mind needles, but my blood sugar tends to run high during plane rides,” he said. I let him know that I was a physician and didn’t mind at all, then told him a story of how I helped a lady who fainted from low blood sugar a few days ago during my flight from Los Angeles to Austin. He replied, “Oh, when my blood sugar gets low to around 50, my eyes pop out so I know to sip some orange juice to bring my blood sugar back up.”

When the flight attendant came around, I watched him request a glass of water and some peanuts as a snack. “My blood pressure was running low today and my doc told me I should have a little salt and some water when I get this way,” he said.

Quite impressed by his self-awareness and knowledge of his medical issues, I asked how he became so pro-active in his care. “I’ve had a great doctor for the last 20 years and he always lets me know when I’m doing something right or wrong when it comes to my health, and I listen because I know he cares.” I looked at him and smiled with a bit of nostalgia and envy as I said, “You’re lucky to have a wonderful doctor.”

Made me wonder how much more proactive and healthier people could be if so much bureaucracy didn’t get in the way of the doctor-patient relationship.

April 2, 2016 16 comments

Medicine Psychiatry

Why I Chose Psychiatry As My Specialty

written by freudandfashion

{Rancho Cucamonga, California}

I am often asked why I chose psychiatry as my specialty, yet as one of my readers pointed out, I’ve never described my reasoning in a blogpost! So here goes my short story of why I chose the path to become a psychiatrist…

The time to solidify your choice in medical specialty and apply for residency training programs occurs during the Fall of the 4th (and final) year of medical school. Students have various reasons for choosing a specific specialty, some knowing which specialty they wanted to go into since childhood, others typically contemplative until right before application season. Some people even change their minds in the midst of residency training and decide to switch specialties.

As a medical student, I attended most class lectures, yet spent majority of the time passively writing notes while chatting on instant messenger. However, when it came to psychiatry, I woke up every morning with excitement to attend each lecture (quite unheard of since I practically dragged myself to every other lecture series), paid attention (and even turned off my instant messenger), thoroughly read the textbook, diligently took notes, and excelled at every exam.

During third year of medical school, students start clerkships, which consists of rotating through various primary care specialties (typically family medicine, internal medicine, Ob/Gyn, pediatrics, psychiatry, and surgery). When interacting with patients during each rotation, regardless of the specialty I was assigned, I ALWAYS spent more time with my patients asking about their psychological and social backgrounds. As a result, I eventually became identified by my senior resident and Attending physicians as the student who would generally be assigned the patients with a history of mental illness or medically-related psychiatric issue. Also, if a patient was admitted to the hospital for physical symptoms, yet the extensive medical workup failed to determine any causative explanation for the symptoms, I was told to assess if there were any emotional issues that might be contributing to a patient’s intractable symptoms (such as cyclical vomiting syndrome, intractable pain, etc).

I specifically remember one patient — a young woman with intractable nausea/vomiting, who was unable to keep down food and fluids. Her medical workup was normal and the medical team could not identify a cause. While the medical team spent only a few minutes to check in on her (to do a quick medical exam and see if she had eaten), I went to visit her after rounds to chat. My intuition told me that there was more to her issue than solely a physical complaint. She was quite shy and spoke only a few words, yet after a few minutes of engaging in conversation, I believe she saw that I wholeheartedly cared about her wellbeing. As it turned out, she experienced ongoing stressors at home due to a recent move with her boyfriend and often felt isolated since she was often home alone with no friends in her new area of residence. I promised to check in on her after daily rounds and she thanked me for taking the time to speak with her.

On the third day, I saw her untouched food tray, and after a few minutes of talking, I asked if she liked ice cream. I brought her vanilla ice cream from the supply in the nurses’ station. We talked about how she missed her family back home. After several minutes into the conversation, I watched her open up the ice cream cup and slowly start nibbling on small scoops. After eating 25% of the cup’s contents, she politely asked for a cup of water. I quickly got up to pour ice water and asked about her little brother as she took a few sips from a straw. Before I left the room, I closely watched her for a few minutes to observe if she’d vomit the contents. She appeared comfortable with no sign of nausea.

The following morning, I viewed the nurses’ report, which noted that she had no episodes of vomiting overnight and even ate a jello snack. I said ‘goodbye’ to her that morning since our medical team informed her that she’d likely be discharged home after lunch. I couldn’t help but wonder if she’d be okay returning home to the same environment that triggered her symptoms. However, the empty plate on her breakfast tray was an indicator that she ate that morning, which reassured me.

Others docs may feel this way about their own specialty, but in my view (currently and as a medical student at the time), there is an art to psychiatry. There are no labs to rely on and although psychopharmacology is of importance, I immediately noticed the value of a therapeutic connection and communication necessary to fully understand an individual’s situation and the context of their symptoms. Despite such a strong emphasis on pharmacology during medical school, I recognized early on how much certain symptoms (even physical) could not be improved solely by medications and standard treatment alone. I recalled reading The Diving Bell and the Butterfly as a medical student, which inspired me to try various different creative ways to communicate with other patients who struggled to verbalize their needs, and had a bit of success with many.

I have several other reasons that contributed to my decision to pursue psychiatry, but wanted to emphasize how much the nature of my connections with patients empowered me as a medical student. The psychological components of a person’s history are often not prioritized when it comes to a patient’s medical care. Throughout medical school, I often felt inferior particularly because I didn’t achieve the highest grades compared to my classmates. However, I knew one thing for certain when the time came to apply for residency: as a psychiatrist, I could play a vital role in emphasizing the importance of an individual’s psychological and social background in order to fully address health and wellness. And I felt confident that I’d do whatever I needed to be damn good at my profession.

Photo by Marlon Santos

March 18, 2016 24 comments

Medicine Psychiatry

4 Reasons Why I Don’t Wear A White Coat

written by freudandfashion

I absolutely love this post written by Dr. Kristin Prentiss Ott about why she believes we shouldn’t wear white coats to work. To carry on with her sentiment, I thought I’d write a few of my own reasons why I personally chose to ditch my white coat even when required to wear one since completing my internship (except for professional photos, of course). Aside from the fact that I’m a psychiatrist, you’d be surprised to know there are still some hospitals where psychiatrists wear their white coats on the unit (the psychiatric hospital where I did my internship was one of them). I used to think it was a bit odd to wear white coats on the psych ward because the look can be intimidating, but I was an intern at the time so I complied. And yes, I recall asking one of the supervising psychiatrists the reason why white coats were worn and remember being told it was by choice? I may have also been delirious and sleep-deprived at the time, so don’t quote me on that.

The following are the reasons why my white coat remains unworn and in pristine condition hanging in my closet:

1. White Coat Syndrome. Yes, such a syndrome exists and is also known as “White Coat Hypertension.” The condition is self-explanatory: a person’s blood pressure is elevated while in the doctor’s office, but is normal in other situations. I was initially quite surprised to learn that anywhere from 15-30% of people experience the syndrome, though I’d have to say the statistic is quite synonymous (frankly, I believe the percentage is even higher) with my own experiences in practice, especially when meeting patients for the first time.

Though one explanation for the fear-based physiologic response might be the association of hospitals/clinics with disease and illness, I believe psychiatric patients are even more prone to anxiety when in the psychiatrist’s office due to disclosures of more personal information and possibly also from bad experiences with previous doctors who weren’t empathetic to their psychiatric issues.

2. Prioritize the doctor-patient relationship. In a study done in an outpatient psychiatry clinic in Upstate New York, 96% of the patient population surveyed preferred that their psychiatrist not wear a white coat, while 58% did not think it would make a difference in their doctor-patient relationship.

Having an aligned doctor-patient relationship is important in any specialty, but even more so with psychiatry due to the personal content discussed. Due to the pressures of time constraints and also the trend of several behavioral health clinics having patients see whomever random psychiatrist has availability, patients are less likely to establish a therapeutic connection, which I imagine would exacerbate anxiety during each visit. I mean, would you want to re-hash your story to a new psychiatrist during each follow-up appointment (but then again, most psychiatrists don’t have enough time to review your whole history, so sessions become mostly limited to a discussion of symptoms only)? Minimizing any factors that can contribute to anxiety (such as wearing a white coat) would at least help a patient feel more at ease.

3. They’re filthy and teeming with bacteria. I have traits of OCD (Obsessive-Compulsive Disorder), yet vividly recall disgusting moments during internship (where I rotated in various hospital departments) when I knew that my white coat was dingy and long overdue for dry cleaning, yet was way too busy to wash it (think buildup of splattered bodily fluids from various orifices and the numerous times that my white coat sleeves probably brushed my face or came into contact with food I’d scarf down during quick breaks…ewwww). Dr. Ott points out in her post that research has shown that a mere 8 hours of routine patient contact leaves white coats teeming with infectious microbes. These days, the average work week of all medical residents is limited to 80 hours/week and most practicing physicians work an average of 40 to 60 hours/week, which equals a heck of a lot of microbial buildup.

4. Sure, a white coat has maintained its iconicism as a symbol of power, prestige, and intelligence, but a doctor’s identity shouldn’t depend on wearing one. Obviously, I was excited when I received my short white coat during my medical school induction ceremony, but later hated being identified as a novice med student as I walked the hallways of the hospital. Meanwhile, other health professionals from various levels of training wore long white coats indistinguishable from those worn by physicians. After graduating from medical school and transitioning to the longer white coat, I was so excited, yet recognized that I formed too strong of an attachment to my white coat. My dependency on an object didn’t sit well with me. I felt as if I had to wear one in order to possess a sense of worth and importance.

By first acknowledging that I attributed much of my value to an external object (the white coat), I took steps to detach myself from it. I began to curate a wardrobe that conveyed professionalism and my individual sense of style. I made sure that I properly introduced myself to patients and staff, especially when I was mistaken for a nurse or psychotherapist. And I’m not going to lie — initially, I was frustrated by having to correct people on a regular basis, but as I gained confidence in myself (yes, psychotherapy helped) and my skills as a physician, to this day I am rarely ever bothered. Interestingly, I am acknowledged to be a physician far more frequently and I believe it’s because I project a much greater sense of who I am, both personally and professionally. No white coat needed.

PS: A special “thank you” to my friends on Snapchat (freudandfashion) for contributing your opinion when I posed the question of whether or not you’d want your psychiatrist to wear a white coat (11% said “yes” to wearing a white coat and 89% said “no” ).

February 9, 2016 18 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

Medicine

5 Things I Would Tell My Pre-Med Self

written by freudandfashion

Whenever I receive emails and comments from pre-medical students, I reminisce of my ambitious years in college. The most common questions I receive pertain to advice on how to become a standout applicant in order to get accepted into medical school. I’ve mentioned this before in a previous post — I did not perceive myself as a standout applicant (my combined GPA and MCAT scores were below average compared to other applicants). When I started receiving emails from students, I initially felt unqualified to provide advice due to my grades and test scores. Then, I later realized that I can be a motivating source for the nontraditional applicant and those who may not be the most gifted and top ranked in their class. Therefore, I thought I’d do a spin on the email questions I receive by providing advice that I would tell my pre-med self. I obviously wouldn’t change any decisions that I’ve made because each step has led me to the place of satisfaction that I experience in my career today. Yet, being a practicing physician for the last three years, the following are a few things that could have provided a sense of reassurance during my pursuit of a career in medicine.

1. Even if you perform horribly on the Medical College Admission Test (MCAT), don’t give up.

I don’t think there’s any one formula for getting into medical school, but in general, having a competitive GPA and top MCAT scores obviously increases your chances. Unfortunately, I didn’t fall into the category of being among the more competitive applicants, but I applied anyway. I will say that in my experience, I took the MCAT twice and my second exam scores were not that much better than my first, but I still applied in hopes that my personal statement, experiences, and extracurricular activities may compensate a bit. I was honestly surprised to receive several interviews across the country (MD and DO schools). During interviews, I was asked the reason why I took the test twice, and was honest in my response regarding the circumstances that contributed to my low test scores. Ultimately, I was accepted into two osteopathic medical schools.

2. Don’t listen to those who discourage going to an Osteopathic Medical School.

While applying for medical school, I thoroughly researched the differences between being an MD (Doctor of Medicine) and a DO (Doctor of Osteopathic Medicine). Initially, I was only going to apply to MD schools because I was discouraged by fellow pre-med students and forums were terribly biased towards MD schools. I decided to apply to both because I liked the osteopathic philosophy and felt that ultimately my main goal was to become a physician and didn’t care whether that meant having “MD” or “DO” at the end of my name. Essentially I went the full osteopathic route by attending an osteopathic medical school (Western University of Health Sciences College of Osteopathic Medicine of the Pacific), osteopathic internship (Post-Graduate Year 1), and osteopathic psychiatry residency program (Samaritan Mental Health). Due to the information found in forums, I worried a bit about coming off as inferior by becoming a DO instead of an MD, but I turned out just fine, am a proud DO, and feel well-respected by my peers and the medical community. For more info regarding the differences between the MD and DO degree, check out my post here.

3. It’s more about the quality than quantity when it comes to extracurricular and medical-related experiences that you participate in as a pre-med.

If I could say I excelled at one thing as a pre-med student, it was participation in extracurricular activities. I think I knew in the back of my mind that my grades and test scores alone wouldn’t get me into medical school (plus, I wasn’t 100% sure that I wanted to be a doctor until my junior year in college when applications were due. See #4 below), so I focused my energy on ways to strengthen my application and decide whether or not becoming a physician was the career for me. If I could go back in time, I would’ve participated in less activities in order to prioritize more time to relax and study. Because I’m someone who enjoys staying active and involved — in addition to my full-time course-load, I also volunteered in several hospital departments, worked as a lab assistant, volunteered at a homeless shelter, mentored youth in the community, worked as a researcher for more than two years, was an active member in several clubs and a sorority, worked part-time at a bookstore, among other things. When it came time to apply, I listed all of my activities in my medical school application, but mainly focused on two of the most meaningful activities in my personal statement. During interviews, I was also asked to discuss the one medical-related experience that demonstrated my commitment to a career in medicine.

4. You may be pre-med because your traditional family expects you to become a doctor, but if you change your mind and pursue a different career path, they’ll understand.

I’m sure several students can identify with the pressures to become the shining, admired physician that our high-achieving families expect us to be. My family, especially my grandfather (who was my role model), pretty much implanted in my mind as a child that I was meant to become a physician. In the Philippines, physicians are held with such high regard and status. As the oldest of >30 grandchildren, my grandfather invested a lot of time and energy on educating me at an early age (I started reading when I was 5 years old, taught to write in cursive when I was 7 years old, and had daily home study sessions with him after school, etc), so I didn’t want to disappoint him once the time came to choose my career path in college. I truly wanted to be a broadcast journalist, but decided to apply for medical school after my grandfather passed away from cancer during my junior year. After I performed poorly on several exams during my first year of medical school, I blamed my family and parents for forcing me to go into medicine. I feared telling them that I wanted to quit, but when I failed a practical exam, I couldn’t hold it in any longer. Their response shocked me when they told me that all they want is for me to be happy and that they’re proud of me no matter which field I chose. All these years, I was afraid to tell my parents and never gave them a chance to show how understanding they truly can be.

5. Don’t feel guilty about taking time off after college before attending medical school.

If you were to go straight into medical school after college, you would have a total of at least 24 years of straight education before you graduate residency and become a practicing physician (kindergarten through 12th grade + 4 years undergraduate education + 4 years medical school + at least 3 years of residency). After I graduated from residency, I felt like a fish out of water because my comfort zone and all I’ve known my entire life was to be a student. Personal development is delayed during medical school (since education consumes so much time and becomes top priority), so taking time off for a few years in the grand scheme of things will not hinder you in any way. I initially felt guilty for taking one year off after college because I thought that taking time off rather than going straight into medical school demonstrated a lack of determination. Looking back, I don’t regret it one bit. Oftentimes, our education and future careers become our identity, which ultimately results in less time spent engaging in enjoyable activities and connecting with those who make us happy. With the grueling years of medical training ahead, try to prioritize time for yourself to grow as a well-rounded individual rather than devoting 100% of the time solely towards your career.

Photo by Marlon Santos

November 6, 2015 19 comments

Medicine Psychiatry

Reach Out And Connect With Someone

written by freudandfashion

{Rancho Cucamonga, California}

I’m approaching a new phase in my life by moving on to a new practice, which will be my second job out of residency. As excited and hurried as I was to leave my first job and move on to the next, with this being the last week in clinic, I’d have to say that I’m quite sad. I’ve had several friends tell me that they don’t get along with their coworkers, that they haven’t developed friendships with anyone on staff, that they mostly are “in and out” of clinic to see their patients and get all the documentation done while minimally interacting with their peers. How fortunate am I to have developed a sense of family and strong teamwork with those whom I work with?

I hear that one of the drawbacks of going into private practice is a sense of isolation not having a team of professionals to bounce ideas off of or interact with on a daily basis. However, I do know that the practice I’m joining will provide valuable experience learning what it’s like to practice psychiatry in a different clinical setting. And even cooler is that the actions and morale of the group I’m joining have given me enough confirmation to prove that I’ve made the best choice for myself and my career.

If you notice a theme in several of my posts, it’s the concept of “family” and teamwork. I have several patients whose stress levels and depression gets triggered or exacerbated by a sense of loneliness and isolation due to lacking the friendship, camaraderie, sense of belonging, and the support we as humans need. Numerous studies have found that social relationships provide emotional support and contribute to stress relief and better quality of life. The following are some examples of how social support enhances mental and physical health:

Addiction
- Recovery from substance use often leads to the dissolution of former friendships that were associated with an individual’s propensity to use drugs or alcohol. Therefore, recovery-oriented support (such as 12-step programs) are critical early in treatment as someone begins to build and develop a healthier network of support. Higher levels of social support are linked to decrease in substance use whereas lower levels of social support prospectively predicted relapse.

Post Traumatic Stress Disorder (PTSD)
- for childhood sexual abuse survivors, a combination of self-esteem and appraisal support (an individual’s perception of being valued by others and that he or she is capable of getting advice when coping with difficulties) was useful in preventing the development of adult PTSD.
Cancer
- Supportive group intervention for women with metastatic breast cancer has been associated with lower mood disturbances and less maladaptive ways of coping with terminal illness.
Work Stress
- Social support at work has been shown to have direct benefit on workers’ psychological well-being and productivity.

THOUGHT OF THE DAY: Identifying and building your own support network can take quite some time and effort, but the enhancement on your quality of life will make it well worth it. Which supports do you identify as being most integral in your day to day life?

October 22, 2015 21 comments

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