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doctor

Healthcare Lesson On a Plane Ride

{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

Psychiatry

6 Things To Say (And Not Say) To Someone Who Is Grieving

written by freudandfashion

{Na Pali Coast, Kauai, Hawaii}

I always struggle with grief this time of year. Among other stressors, this month also marks the 14th year death anniversary of my grandfather, whom I was extremely close to. You’d think that after fourteen years, the grief wouldn’t hit me so hard, yet it still does. Grief is one of the most difficult emotions we experience as humans, yet is also one of the most commonly misunderstood.

Below are some actions and statements that I’ve found most helpful both personally and professionally in my office when I have patients coping with grief. I initially drafted this post last week while in a combined state of anger and sadness (predominantly anger) related to grief. I contemplated deleting the initial draft, which I titled “Things You Should Never Say To Someone Who Is Grieving.” However, since I try to maintain authenticity on my blog, I decided to leave the section I wrote while in an angered state, particularly because people frequently experience anger, yet often internalize and feel too ashamed to express the emotion. People need to recognize that grief does not consist of only sadness. Grief is a complex emotional roller-coaster that may involve one or a combination of emotions such as anger, rage, sadness, guilt, depression, joy, denial, shock, disbelief, confusion, frustration, exhaustion, apathy, numbness…(I think you get the point).

Since people often feel clueless about what to say to someone who is grieving (trust me, I struggle sometimes with what to say as well), I hope that you will consider the following when you or someone you know is experiencing grief:

Things You Should NOT Say To Someone Who Is Grieving:

1. “It’s been ___ days/weeks/months/years already…you should be over it by now.” Grief has no timeline. The closer a relationship someone has with the deceased, the longer it may take to overcome the painful emotions. As one of my amazing readers (whom I learned a lot from since he shared his experience with losing a child) pointed out: grief never fully goes away, but rather becomes more tolerable.

2. “Just try not to think about it.” Telling someone not to think about losing someone is like telling someone not to be human.

3. “‘So-and-so’ has already moved on…you should too.” Comparisons are terrible because each individual person has their own process of experiencing grief.

4. “Just be strong.” Saying this statement actually does the opposite and evokes a sense of weakness for not being able to overcome such strong emotions that may feel outside of one’s control.

5. “I know how you feel. My ____ died…” Don’t even try to make the difficult situation more about you. I once sought support from a peer and confided in my sadness only to have her shift the focus to herself and her past losses (and she was a psychotherapist!). Though I’m sure her intentions were good, a part of me wanted to punch her in the face for wasting my time and energy.

6. “He/she is in a better place now.” I’m a little mixed about this statement because it can be comforting if used in a thoughtful way, but annoying if said generically as a reflex response. For example, when my grandmother passed away, I felt comforted when a relative said “She’s in a better place now with your grandpa in heaven” because my relative knew of my grandparents’ enduring love for each other having been married for >50 years, in addition to our spiritual beliefs. However, when an acquaintance says the statement in a generic manner, it doesn’t feel genuine at all.

Bottom line — don’t say anything to someone who is grieving unless you truly, wholeheartedly mean it. If it doesn’t feel authentic to you when saying it, then it most definitely won’t feel authentic to the person who is grieving. And if you’re not good at verbally communicating your thoughts, then read on to see how your actions can be just as helpful (if not more).

Helpful Things To Do/Say To Someone Who Is Grieving:

1. Just be present. Actions speak louder than words, especially during such a difficult time when grief tends to be a very isolating experience. Being present shows that you’re aware of how difficult the experience is and that you won’t let them go through it alone.

2. Give a hug. Several years ago, I was sitting in a lecture during residency when I received news that my grandmother passed away. During the state of shock, I truly appreciated when my co-residents gave me hugs especially knowing that there was nothing they could say to make me feel better at that moment. Giving me a hug showed that they acknowledged the news and wanted to show that they cared.

3. “If you ever need to talk to someone, I’m here for you.” Again, showing your support and offering your help when needed demonstrates that you care.

4. “I’m so sorry to hear the news” or “I’m so sorry about your loss.” Often, when people don’t know what to say, they may avoid saying anything at all to the person grieving. Avoidance is one of the worst things to do to someone who is grieving because one might assume that you don’t care, which most likely isn’t the case. Saying something as simple as this statement acknowledges that you’re aware and recognize the impact of the person’s loss.

5. “I’ll be thinking/praying for you and your family/ (anyone else known to be deeply impacted by the loss).” Expressing that your thoughts (or prayers if the person is religious/spiritual) are with someone shows that you know this is a difficult/tough time for everyone involved.

6. “I know I can’t say anything to take the sadness away, but just know that I’ll be here to support you.” This is such a true statement — nothing you say can bring the deceased back to life nor take the pain away, so offering your support and presence speaks volumes to someone who is struggling during bereavement.

February 23, 2016 22 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

Psychiatry

Quick Reflections From The Week

written by freudandfashion

{Napa, California}

I’d like to think that I’m quite mindful and reflect on almost anything that stands out in my day causing me to raise an eyebrow or feel that a mini light bulb went off in my head. I truly believe that the more mindful we are and the closer attention we pay to cues and details, the more meaning we can get out of even the most routine of days. The following are some of my own reflections from the week, and I hope to encourage you to reflect and do the same!

The importance of teamwork. As a psychiatrist who values coordination of care and hearing other clinicians’ perspectives, I had the opportunity to connect and discuss cases with an awesome psychologist whom I share several patients with. Being in private practice can feel a bit isolating at times compared to working in a multidisciplinary setting, so I welcome the opportunity to meet and discuss any complex psychological issues that might be impacting my patients. As several of you may know, I place a much stronger emphasis on psychotherapy than pharmaceuticals when treating my patients. Therefore, knowing that therapists value my opinion on psychotherapy just as much (or even more) than my expertise in pharmacology helped me feel connected and valued as a team member.
Be authentic and speak up. Since I posted my latest blogpost on physician burnout, I’ve received amazing responses from people telling me that they could relate to my post. As someone who was always afraid to share my opinion (yes, I’d go to leadership meetings and literally sit there and say NOTHING), it was a testament to how much personal work I’ve done to overcome barriers that got in the way of me voicing my opinion. I think clinicians can be hypocritical by simply telling patients to exercise more, think positive, stop thinking so much, eat healthier, etc, and even worse if they label patients as ‘non-compliant’ for not executing such changes by their next follow-up appointment. As if breaking years worth of habits is that easy. Well, I can say that it took me years to overcome my overwhelming fear of judgment in order to speak up and I’m just happy to have the support of empathetic people who helped me achieve it.
Normal vs Pathological. During sessions with patients, I try to help them discern whether the symptoms they’re experiencing are normal reactions given their circumstances. This week, several patients chose to hold off on increasing medications after recognizing that they were coping with issues in a fairly healthy manner. Often times when people are diagnosed with mental illness, any anxious feeling, sense of fatigue, anger outburst, difficulty sleeping, etc, is automatically perceived as problematic rather than a ‘normal’ response. I’m far more collaborative in my approach, and part of the treatment involves determining whether or not a symptom is ‘normal.’ The decision-making process of determining whether or not to adjust a patient’s med is geared towards first helping my patients gain insight rather than automatically assuming that their symptoms are pathologic.
“To find health should be the object of the doctor. Anyone can find disease.” ~ A.T. Still. I am currently reviewing osteopathic principles for an upcoming presentation, and while reading I came across this quote. There are times during appointments when I’m stuck on which medication to prescribe next, though I noticed that I experience clarity the moment I get an opportunity to practice the above quote with my patients. I have several patients who have tried an extensive list of meds, yet start to observe more improvement when the sessions shift from solely focusing on meds to helping them heal from years of trauma, neglect, medical illness, heartbreak, addiction, etc. Doing so reminds me of the reason I pursued a career in medicine in the first place.

January 16, 2016 5 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

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

Psychiatry therapy

The Crucial Transition From Work to Home

written by freudandfashion

{Beverly Hills, California}

One of my patients told me that the most frustrating part of his day occurs the moment he arrives home from work when his family accuses him of being isolative and uninterested (due to his first activity upon arrival consisting of sitting in his parked car in the driveway and/or watering the lawn instead of immediately engaging in family affairs). When my patient told me this, I actually thought about my own behavior upon arriving home from work, and to be honest, I can be pretty bitchy. That is, unless I allow proper time to switch gears from work mode to home mode. Those who live with me have observed that my mood typically goes from snappy/serious/irritable to talkative/cheery/joking over the course of 30 minutes.

Not much research exists on this topic, but I assume that there are various reasons that the lingering effects of work can have a negative impact upon arriving home. Here are a few factors to consider that may contribute to the tough transition:

Traffic congestion – feeling trapped in your car, moving inches on the freeway, dealing with aggressive drivers, running behind in your schedule due to delays, and the potential threat of car accidents are all factors that can easily raise one’s heart rate, blood pressure, level of arousal, and automatically trigger you to go into a protective/defensive mode.
Work stress – having an extensive to-do list, meeting project deadlines, dealing with coworkers’ differing personalities, tolerating conflicts in opinions of supervisors or administration, etc, are all situations in the work environment that require excess mental energy to deal with, leaving incomplete tasks and unresolved issues that may carry over into the home environment.
Home responsibilities – in a perfect world, we might be able to come home after a stressful day and be able to relax and worry about absolutely no other responsibilities. Yet, in reality, leaving work means moving from one set of responsibilities to another (children or a spouse demanding your attention, chores to complete, dinner to prepare, bills to pay, friends’ events to attend, etc).

How to make the transition:

Establish a routine that works for you. This involves evaluating your current routine going from work to home and incorporating practices that help you eliminate or get around triggers and negative thoughts. The Wall Street Journal published an article about “rethinking your after-work routine” and I definitely agree with Cali Williams Yost‘s recommendation to think about the transition from work to home in terms of three stages: leaving the workplace, getting home, and walking through the door.

Stage 1: Leaving the Workplace
- To ward off negative feelings, consider a routine that acknowledges your accomplishments of the day or think about positive things that occurred during your day.
  - I make sure to leave 10 minutes at the end of the workday to look at my list of accomplishments (ie, the items I checked off on my to-do list) and prioritize tasks left to complete the following day. This routine works for me because I’m left with a sense of accomplishment focusing on the tasks that I actually DID complete, rather than focusing on what I did not complete. I also like to organize and tidy my desk so that upon arrival to work the next morning, I feel as if I’m starting new rather than being left with a sense of disorganization from the previous day. I also try to check in with the nurses and thank them for all their hard work from the busy day.
Stage 2: Getting Home
- As mentioned above, the commute from work to home can evoke excess stress, so consider methods to minimize aggression.
  - I always admired one of my mentors during residency because he’d bike home from work (something I’d consider doing if I still lived in Oregon rather than southern California), but since it’s far easier for me to drive, I make sure to blast uplifting music on the radio or talk on the phone with one of my close friends (who is also a psychiatrist that commutes home around the same time of day). I also may volunteer to make a stop at the grocery store, which allows additional buffer time before arriving home.
Stage 3: Walking Through The Door
- Identify triggers that may set you off upon arriving home (ie, your children demanding your attention, the need to cook dinner, a messy home in need of cleaning, etc) and figure out ways to get around the triggers.
  - For example, I suggested to my patient above that he communicate to his family the need for a few minutes of alone time each day after work to water the grass or sit in his car.
  - For me, I am easily triggered when I come home to a messy kitchen, so in the morning I try to empty the dishwasher and load any dirty dishes left on the counters or sink.

Thought of the Day: What are some practices that you can incorporate into your routine to ease the transition from work to home?

October 1, 2015 12 comments

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