Tag:

health

Questions I Bet Your Psychiatrist Never Asked You

During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. Every psychiatrist has their own style, but I’ve always been interested in asking patients more open-ended questions if I think it will provide me with a greater understanding of who they are as unique individuals. Unfortunately, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis and treatment plan based on the minimum criteria needed to properly meet billing requirements. Such a practice may lead to a lack of connection in the therapeutic relationship, therefore, I sought to create a series that explores the unspoken thoughts that a person may have when meeting with a psychiatrist. If you would like to contribute to future questions in this series, please email me at freudandfashion@gmail.com or add me on Snapchat (freudandfashion).

QUESTION OF THE WEEK:

What do you wish you could tell your doctors when they makes changes to your meds that you don’t agree with?

RESPONSES:

I have definitely been through this experience! I WANT to say that increasing the dose scares me as the side effects I’ve experienced were horrible. I also feel that some (not all) psychiatrists barely ask you any questions about your research on medications. I feel that they don’t want to believe that you are actually capable of being educated on the topic.

Paramedic Nat (Blog: paramedicnatsmentalhealthjourney.wordpress.com, Twitter: @paramedicnat1)

Ever heard the word ‘advocate?’ Did you get your degree for the high status and income, or are you sincere about helping those of us trapped in this system? Why not take a stand against the big pharmacy industry and be true to your patient and what is best for him or her?

Anonymous

Well, to be honest, I don’t think it would be something to say but more to feel. For example, for me, as the side effects were horrible, and as I wasn’t feeling better, she kept upping my dosage. I wish she would have FELT my side effects. I described it as best I can, but I’m not sure all docs felt brain zaps. I wish doctors would listen more to how we feel instead of maybe just push various pills and dosage on us. Those are pills for our brain, it’s nothing to joke about. I’m sure it affects us all differently. But I wished they’d be more open to the fact that for some of us, medications (or SSRIs and such) just aren’t doing any good.

Natalie, Teacher (Twitter: @natricher)

What I absolutely love and appreciate about my psychiatrist is that he lets me choose what I’m comfortable with taking. I don’t know if other patients are like this, but I know my diagnoses and I do research on different meds. I haven’t found anything that’s working greatly yet since I do have a lot of different disorders, but knowing that my doctor validates what I’m comfortable with doing makes me feel that much better.

For example, I really dislike the weight gain side effect that a lot of medications for bipolar disorder have. I suffered major self-esteem issues in middle school because I put on 50 lbs from lithium and depakote combo. He knows how hard I worked to get that weight off and feel better about myself, so we only talk about combinations that will make me feel comfortable taking…so that I actually take my medicine.

Alexandra, Advocate

I wish they would have taken the time to explain (simply) what the medication will be doing to my body/brain and why it’s more efficient than what I was previously taking.

Anonymous

I honestly would tell the doctor my concerns. I wouldn’t be rude, but I would openly say that I have concerns over it. My hopes would be that it could open up a two-way conversation regarding my care and I could find out what they have to say (and have them see where I’m coming from).

Tom V, 1st year Medical Student

I wish I could’ve sat down with her and said clearly: “I’m sorry I called you two times today freaking out, but this medicine you gave me just isn’t working right–it’s making me worse. I’ve never taken any meds before and I’m running scared here and I need someone to understand me and sit with me and talk about my options. I know we didn’t meet under ideal circumstances and you don’t know me or I don’t know you, but don’t treat me like I’m one of the people who bug you all the time. Please help me. That’s all I need is some help.”

But, I now have someone who I think is amazing and he talks to me about options and is more of a collaborative force in my health care. He is in charge of my meds, but he has listened to me and I’m glad to say I haven’t had to take one benzo, not one single one in over 6 months so the fact that a doctor will collaborate makes me very happy, and listens.

Anonymous

Photo by Marlon Santos

March 2, 2016 20 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

Series

Questions I Bet Your Psychiatrist Never Asked You

written by freudandfashion

During new patient evaluations, psychiatrists generally have a standard set of questions that are asked to help formulate a diagnosis based on diagnostic criteria and to develop a treatment plan. Every psychiatrist has their own style, but I’ve always been interested in asking patients more open-ended questions if I think it will provide me with a greater understanding of who they are as unique individuals. I also assume that my questions might be a bit different than the norm because I’ve grown accustomed to patients making statements such as “You know, nobody’s ever asked me that before.” Oftentimes, I believe that the art of psychiatry has dwindled down to a checklist which subsequently churns out a diagnosis based on the minimum criteria needed to properly meet billing requirements. Such a practice may lead to a lack of connection in the therapeutic relationship, therefore, I sought to create a series that explores the unspoken thoughts that a person may have when meeting with a psychiatrist. If you would like to contribute to future questions in this series, please email me at freudandfashion@gmail.com.

QUESTION OF THE WEEK:

What goes on in your mind when a new psychiatrist asks if you’re suicidal?

RESPONSES:

It’s been some time since I’ve seen a new psychiatrist; thankfully I’ve been (somewhat) stable and happy with the treatment I’ve been receiving with my current one. But I do remember going through what was round-robin of mental health professionals before I found my current doctor. The situation is horrible, as I’m sure most people who have gone through the same process can testify. Although someone may be a professional who’s gone through years of grad school and training about what may be wrong with me, why would I want to share my darkest, deepest pain to someone I just met? It never felt right.

The two psychiatrists whom I connected with most during my care have been the ones that treated me like a person (and even a friend) first. No, I’m not that textbook case study you read in Psychology 407 back in grad school. Nor am I willing to try new psych medications with the script you’ve given me after our 5 minute visit.

There are no 100% effective cures for mental illness, but you can still treat those living with mental illness like human beings. It’s not that hard.

Brandon Ha, Creative Director @BreakYoStigma

facebook.com/breakyostigma

instagram.com/breakyostigma

First thing that springs to mind is: “I can’t tell you I’m suicidal because you’ll hospitalize me and that will just ruin everything I’ve worked so hard for.” (as strange as that sounds…)

However, I always think there’s no point in outright lying to my psychiatrist if I genuinely want to get better. So, usually, I just tell them what I’m thinking, even if it means telling them I’m suicidal. But, I make sure I explain exactly what I’m thinking. Usually my thoughts are more of a passively suicidal nature and I don’t have a concrete plan in mind. My current psychiatrist is well aware of that. I haven’t had suicidal ideation with a plan for quite some time now. The last time was with my first psychiatrist, two years ago. And even then I’d tell her the truth. I only got hospitalized once, when I told her I genuinely couldn’t guarantee that I wasn’t going to do it. I guess the fact that I’m always honest about what goes on in my mind is precisely what has helped me not get hospitalized more than once. I’ve always thought of the patient-psychiatrist relationship as one built on trust. If they can’t trust me then they can’t help me to the best of their capacity and I’d just end up self-sabotaging.

Dana S, medical student (borderlinemed.wordpress.com)

‘I’d never kill myself. Wanting to die to end my misery and actually going through with it are completely different. But that’s probably not the answer you were looking for…’

Rudy Caseres, Voice on Mental Health

Facebook.com/Rudy.Caseres

Twitter: @RudyCaseres

First thought in my head if asked if I was suicidal would be something sarcastic like this: ‘Would I be sitting here if I was [suicidal]?’ and/or ‘Yes and to be honest, you’re just having a visual hallucination of myself right now.’

Anonymous

What goes on in my mind? Terror yet the need to be honest and tell the psychiatrist if I’m feeling that way. From experience (I was hospitalized several times for suicidal ideation) I know I had to be truthful about feeling suicidal because despite the intense compulsion, I didn’t want to do it and leave my two young daughters without their mom. I needed to be kept safe so I didn’t go through with it and I knew I needed hospitalization. I got better, and if the feelings return I will be honest with my current psychiatrist. I realize that he would most likely place me on a 5150 hold, but I accept that.

Dyane Leshin-Harwood, author of “Birth of a New Brain – Healing from Postpartum Bipolar” (Post Hill Press, 2017). Blog: www.proudlybipolar.wordpress.com, Twitter: @birthofnewbrain

The first thing that comes to mind is that I need to justify why I’m there seeking help at this appointment and I wasn’t really sure how I need to respond. I was asked to rate my suicidal thoughts on a scale of ‘1 to 10’ (1 being the least severe and 10 being the most severe) and thought to myself, ‘do I need to respond with a high number so that I can get the help that I need, or will a low number not make them take me seriously enough?’ I remember feeling like I needed to justify that I needed help and it seemed as if a number was supposed to prove it. I get that a number is supposed to reflect my thoughts and feelings, but I didn’t feel like it was a genuine representation of my situation.

Anonymous, Psychotherapist

Having seen a psychiatrist in the past, I remember feeling anxious about this question because I knew what to expect in an evaluation, even though I didn’t feel suicidal. Fortunately, I knew the psychiatrist came highly recommended, was well-established in the community, and was someone I could trust, but what if I had no choice but to see a random psychiatrist (quite similar to the experiences many of my patients have encountered in the past) who was a novice, unskilled, or didn’t care to take the time to get to know or properly assess me? A psychiatrist’s job is hard and safety is our utmost concern, but building trust and mutual respect in a physician-patient relationship also needs to be a priority.

Vania, Psychiatrist and writer of Freud & Fashion

Photo by Marlon Santos

January 22, 2016 14 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

therapy

Express Gratitude Daily

written by freudandfashion

I rarely used to tell people that I appreciated them. I recall rejecting and criticizing kind things done for me, gifts given to me, etc, mostly because I focused more on the superficial/material aspect rather than the thoughtfulness and intent. When people tell me that I possess a “positive energy,” I’m often a bit surprised because I used to exude such negativity. One way that I was able to shift my perspective was by expressing gratitude on a regular basis. Such a feat isn’t as easy as people may believe. Solely telling someone that they “just need to be more positive” doesn’t help much, or at least I find those statements quite annoying because such statements negate the fact that there’s probably an underlying reason for the lack of optimism (ie, low self-esteem, depression, traumatic upbringing, grief, etc). The expression of gratitude takes time and practice, and when you’re not used to sincerely telling people that you’re thankful, then it’s going to feel awkward at first. For example, if a relative buys you a hideous Christmas sweater, focus more on the kind gesture rather than the dissatisfaction of the gift itself. As time goes by, the practice takes less effort and feels more sincere (ie, “Thanks Aunt Sally, the sweater will keep me warm during the winter months”).

If you need even more motivation to be thankful, the expression of gratitude also has many benefits: increased happiness, better physical health (more willingness to seek medical help, more involvement in physical activity), and increased self-esteem, to name a few.

In addition to sincerely saying “thank you,” the following is a list of strategies that may enhance feelings of gratitude (experiment and find out which ones work best for you to carry out on a regular basis):

1. Write a “thank you” note. Some people feel more comfortable with writing than verbalizing. Giving someone a note shows that you took the time and effort to write a few kind words.

2. Keep a gratitude journal. Take some time at the end of your day to recall 1-2 things that you were thankful for, or you can also designate one day per week to reflect on the things you were thankful for from the week. I’m not organized enough to carry a journal (I ended up writing on post-its which would clutter up my nightstand), but think it’s a great way to keep track of things you’re grateful for on a regular basis. My variation of journaling is doing a weekly “Thankful Thursday” post on my Snapchat (my username = freudandfashion if you’re interested in my weekly reminders).

3. Think of what you’re grateful for (as a regular practice, or during prayer if you’re religious). If you’re like me and can’t remember to write in a journal, then practice thinking or saying aloud to yourself what you’re thankful for from the day. Choose the time of day (I prefer bedtime right before sleep) and make it routine.

4. Express gratitude directly in person. This is my preferred route. As a psychiatrist, I strive to make sure I communicate directly because I believe it’s integral in relationships, including the development of good therapeutic connections with my patients. Ways to express gratitude directly includes buying coffee for coworkers (coffee at work always makes me happy!), taking a friend out to lunch, stopping by to visit a friend, etc.

5. Shift your perspective from negative to positive. If you find yourself in an angry mood, try shifting your focus by thinking of something that went well during your day. If you’re stuck in traffic and find yourself getting tense and irritable, try to express gratitude at that very moment. Saying what you’re thankful for can shift your mood as it changes your focus.

A lot of people tend to think that you have to express thanks for only major things such as having a supportive family, an education, a decent job, etc, but you can definitely be thankful for even the smallest thing that went well during your day. I’ve expressed gratitude for things such as hitting all green lights on my commute to work, seeing a cute dog that made me smile, not getting a parking ticket while out in Hollywood, etc. Basically, you can always find something to be thankful for. And with today being Thanksgiving, no better day to start implementing this practice than today!

I wish all of you a happy Thanksgiving! xoxo, Vania

Photo by Marlon Santos

November 26, 2015 19 comments

Featured Guest Blogger

Why A Pre-Med Student With Bipolar Disorder Posted on YouTube Against Medical Advice

written by freudandfashion

{Logan’s transformation leading up to disclosure of his mental illness}

I recall browsing through Logan Noone’s Instagram last year, taking note of his scenic photos of the great outdoors and noticing the huge smile on his face pictured standing on snowy slopes or sitting among friends at sporting events. His profile stated he was a mental health advocate, and other than that, my assumptions of him were based on his seemingly happy and active lifestyle. Fast forward to a few weeks ago when I received a thoughtfully edited email from Logan informing me of his status as a non-traditional pre-medical student in pursuit of a career in medicine, particularly Psychiatry. What stood out and impressed me the most about Logan was his tenacity — little did I know that behind his picturesque Instagram posts was a man who battled and has since gained control of his bipolar disorder. After watching his viral YouTube video about recovering from bipolar disorder, I knew that he’d make a valuable asset to the medical community to advocate for change and reduce stigma, especially since the culture of the medical field tends to discourage such disclosures of having mental illness. Therefore, I’m excited to have Logan contribute to my blog as he discusses his motivation to become a physician and how the school shooting at Sandy Hook influenced his decision to go public with his diagnosis.

__________________________________________

“There is an old story about a blind man heading towards a well, and there’s a guy who’s watching. If the blind man falls into the well, who gets the blame? If you’re watching something you can prevent, you’ve got to do something.”

– Manoj Bhargava

It’s February of 2013, about two months after the devastating shooting at Sandy Hook Elementary School in Newtown, Connecticut. The total fatalities are still hard to swallow: 20 children, 6 staff members, and the mother of the shooter were found dead on December 14, 2012. The entire world was shaken and struggling to find a reason for this senseless tragedy. The storyline seemed all too familiar: a person suffering from mental illness committed horrific gun violence.

Now, let’s rewind the clock about 8 months. I was 22 years old and newly graduated from college. While the rest of my classmates were celebrating after graduating or starting up a new job, I found myself in the emergency psychiatric ward. Two years of severe mood swings, alcohol abuse, insomnia, anxiety, and a breakup culminated in my first manic episode. I found myself overwhelmed with euphoric feelings, rapid speech and grandiose thoughts. This feeling continued to evolve over the course of 5 days with no sleep, paranoia, and auditory hallucinations.

I displayed the basic symptoms of bipolar disorder. Also, considering my family’s history of the disorder, it was pretty easy for my psychiatrist to diagnose me with Bipolar Disorder Type 1. The medical staff outlined how I would have to live my life with the support of medication, therapy, and support systems. However, the medical staff also indicated I needed to be cautious whom I disclose my bipolar disorder to. “People’s opinions could change when they find out you have bipolar disorder. It could hurt your employment, housing, or social life.”

Fast forward back to February 2013. I hardly told anyone about my mental illness, I was insecure and utterly hopeless. Images of the Sandy Hook shooting were everywhere. It seemed like the public stigma towards mental illness literally could not get any more intense.

To understand my struggle, consider that I grew up about 40 minutes north of Sandy Hook elementary. My mom is an elementary art teacher, and my father served on the public school board in our town for nearly a decade. I knew I could never commit a crime like Sandy Hook. But, because of this tragedy and other similar shootings, the public perceived my mental illness as a threat.

People with mental illness can recover, and they are more often victims of violence rather than the perpetrators. If I continued to remain silent about my mental illness, there was no way I could expect the stigma surrounding mental illness to change. I knew that I had to help repaint society’s poorly painted picture of mental illness and lead by example.

Living openly with my mental illness would require bravery, or so I thought. During February of 2013, I finally joined a mental illness speaker’s bureau and shared my Bipolar Disorder Recovery Video online. I quickly realized my expectations for being publicly open about my mental illness were different from reality. Saying that I received an overwhelming amount of positive support would be an understatement. Within two weeks, the video had over 15,000 views. The video was shared by many of my friends, reposted on numerous mental health websites, and featured on Fox News. I connected with old friends and even new people from all over the world.

I was pleasantly surprised by the amount of support I had received from my disclosure. Perhaps people are more accepting of mental illness than I expected. I originally thought being open about my mental illness would require a courageous effort. I was wrong.

Being open about my bipolar disorder is simply a logical and honest choice. 1 in 4 adults suffer from some type of mental illness. It’s only logical that our society start to recognize and accept that we all will be personally impacted by mental illness in our own life or through someone we love. The mere statistics prove that there is an incredible amount of people just like you in the world.

I’d be lying if I said living openly with my mental illness was all “smooth sailing.” Of course, I’ve met people that aren’t supportive of mental illness or its treatment. Numerous times, I’ve had people tell me mental illness isn’t real, or my medication will simply turn me into a zombie. I’ve even been congratulated that I am not violent because of my bipolar disorder. Um, thanks…

But I don’t let these negative incidents regret my decision. When I first encountered these opinions, I was furious and insulted. But now, 3 years after my disclosure, I’ve grown wiser in my demeanor. It would be naïve of me to think that a social change could occur without a few bumps in the road. Now, rather than be upset by ignorance, I get motivated by it, and do my best to change opinions through a healthy and respectful dialogue.

My openness has changed what I want out of my career. I found that simply acknowledging my mental illness allowed others to feel comfortable talking to me about their mental health challenges. There is no better reward than knowing that you helped someone also fight mental health stigma, pursue professional help, or better yet, stop them from hurting themselves.

Shortly after disclosing my mental illness, I decided I wanted to work in the mental health industry in some capacity. I felt I could make the biggest contributions to mental health if I help improve the scientific understanding of our brains and mental illness. Frustrated by my own personal experiences with psychiatrists, I want to be a psychiatrist that could connect with their patients in a more natural manner and help inspire them to tackle stigma head on as well. With that in mind, I am currently preparing to apply to medical school in 2016.

Being open about my mental illness helped me find my own inspiration, passion, and drive. I couldn’t simply be a bystander to a problem I knew I could help fix. That’s my style.

For more info on Logan Noone, check out his YouTube Videos below. You can also find him on Instagram.

Bipolar Disorder Recovery Video: https://www.youtube.com/watch?v=bvdrFowzG94

Sacramento NAMI Walk Speech 2013: https://www.youtube.com/watch?v=KRKQSyPYIEE

November 17, 2015 5 comments

Psychiatry therapy

Tips To Control Your Angry Mood

written by freudandfashion

{Monterey, California}

Up until I graduated medical school, I used to be irritable and impatient on a regular basis. Not many people would think I had anger issues (particularly due to the way my anger manifested, which was mostly unassertive and passive, see below) except for those who received the brunt of it, which is often the case for most people. I also used to feel guilt and shame for having an angry temperament as a child, until I opened up about the issue during individual and group psychotherapy. It was quite therapeutic to hear that several group members (whom I least expected given their present demeanor) reported being angry during childhood as well, and even more helpful to gain the insight needed to identify triggers for my anger, in addition to more productive ways to express and cope with it.

We’ve all experienced anger before, and there’s various ways it can present itself. The spectrum of anger can manifest as brief, subtle annoyance to full-fledged rage. Though anger can be constructive (ie, used as motivation to create change or solve a problem), the more problematic expressions of anger are more outward via yelling, physical aggression (punching and throwing things, etc), or violence. Others may also express anger in an unassertive way (which can also be quite volatile) by isolating, holding it in, and not expressing the anger at all which often leads to more passive-aggressive and pathological forms of coping such as taking it out on others via hurtful comments, putting people down, being vengeful by indirectly trying to get back at people without communicating the reason why, etc.

Developing healthier ways to express anger has many benefits, which include health (anger is known to be associated with increased risk of having a heart attack, hypertension, diabetes, migraines, self-medicating with substances such as alcohol, etc), improved communication in relationships, and a gained sense of control over your emotions. Though the origin and persistence of your anger can be quite complex to fully understand (I tend to formulate my patients’ issues psychoanalytically, which can be theoretically confusing to many (including myself) except Sigmund Freud, who first laid out the theory), the following are some concrete strategies that can help keep your anger in check, which I also teach my patients and use on myself:

1. When your anger gets triggered, slow your response rather than reacting on impulse.

When anger gets triggered, our brain perceives the situation as a threat and automatically reacts by going into fight or flight mode and the response is believed to last less than 2 seconds. Therefore, since we can go into a rage from 0 to 100 instantly, we can take control of our behavioral response by using tactics that allow us to regroup and think through how to respond. Some tactics include the following: take a couple of deep breaths, count to 10, step away and excuse yourself briefly, grab a drink of water, etc.

Another similar example/situation — Have you ever received an email or text message that was so upsetting that you immediately started aggressively typing a hostile reply? I’ve reacted this way many times (and have also typed blogpost drafts out of anger), yet the rule of thumb is do not send content that is typed in a heated, angry state of mind, but rather to wait and respond when you’ve cooled down because you might send something you’ll regret (and an email/text message is a permanent record that you can’t take back).

2. Recognize your initial signs of anger.

I often ask my patients to identify the initial signs they experience when anger gets triggered because being mindful can put a stop to the progression to an outburst or response they might regret. Utilizing Tip #1 above is even more useful if we can quickly recognize our body’s initial response to anger.

To give an example, the following is my usual pattern of response that occurs when my anger gets triggered: eyes get wide, chest tightens, heart races, facial muscles tense, fists tighten.

I’ve practiced this technique numerous times and have become far more mindful and self-aware in the last few years (therapy and yoga helped) to the extent that once I notice my chest tighten and heart race, I quickly take deep breaths to calm down. So next time you get angered, pay attention to how your body responds.

3. Once you’re in a calm state of mind, express your anger.

When people hold in and suppress their anger, it often becomes internalized (and may experience depression by directing the anger inward) or builds up to the point that it leads to an eventual huge, uncontrollable outburst. I used to cope this way with anger as well where I’d yell and scream hurtful things and bring up anything and everything that upset me in the last few months. Once you’ve calmed down in the moment, try to assert and state your concerns in a clear, direct way rather than waiting until you’ve reached your boiling point.

I admit that I used to also react by either saying nothing or passively turning to someone next to me and saying mean, hurtful things that were loud enough for the person who upset me to hear (yes, I know this response is sooo high school circa Rachel McAdams in Mean Girls), so I felt awkward at first when practicing to be more direct at communicating my anger. However, just like with anything in life, you have to keep practicing and eventually you’ll learn to successfully express yourself and get your point across in order to feel understood and heard.

4. Identify the underlying cause of your anger in the moment, and if the issue is minutiae, let it go.

Numerous things can trigger anger (a negative comment, criticism, lack of sleep, not getting your coffee fix, drugs, depression, medications, anxiety, stress, grief, kids not doing their chores, your sports team losing, bad luck with fantasy football picks, a friend wearing the same outfit as you, a pimple, tardiness, misinterpretation of a text message, someone lying to you, PMS, delayed flight, someone cut you off on the freeway, etc, etc — I think you get the point). If the trigger is something small and trivial (ie, getting cut off in traffic), recognize that reacting in anger won’t solve the issue (that’s right — stepping on the gas and tail-gaiting the SOB will not make the situation any better…I only know this through experience) and expends so much energy that can be more productively utilized elsewhere. However, if the underlying cause might be a major issue you’ve struggled with throughout your life (for example, having social phobia and being extremely sensitive to judgment and criticism) then please refer to #6 below.

5. Diffuse your anger by getting some exercise or channeling that energy into a workout.

This point is pretty straightforward — anger triggers increased stress and exercise is always a good way to lower stress and expel the anger from your system.

6. Seek professional help.

If your anger is causing substantial impairment in your life (work, relationships, etc), then don’t be afraid to seek help from a professional (psychotherapist, your regular medical doctor, psychiatrist, anger management, etc). I mention numerous times in my blog how much psychotherapy has helped me personally and those I’m closest to can vouch for the noticeable improvement in the way I manage stress and anger.

November 13, 2015 13 comments

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