Tag:

lifestyle

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

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

Personal Independence Day

written by freudandfashion

{Malibu, California}

I recall previous 4th of July holidays spent working in the hospital, or on-call with my pager held tight as I nibbled on barbecue anxiously anticipating a flurry of calls regarding the behavioral management of alcohol-intoxicated patients. This year, however, I am free from the responsibility of being on call, free from the hospital, free from clinic, but NOT free from the mentality that I SHOULD be productive and get items A-Z done on my to-do list. Doctors tend to be perfectionists, overly self-critical, driven, competitive, which usually means that putting their “workaholic” tendencies aside in order to relax can be quite difficult. Well, at least that’s how I feel, but I’m working on it.

So, today after 12pm I intend on putting my computer, to-do list, and anything work-related aside for the sake of my own health and sanity. I think it’s about time to enjoy the traditions of this historic event in America, especially since barbecue and the beach sound far more appealing than doing paperwork and organizing my house.

Thought of the Day: Any other workaholics with me on this? Do you allow yourself to put work aside during holiday weekends?

July 4, 2015 9 comments

Psychiatry

7 Ways Exercise Improves Mental Health

written by freudandfashion

{Rancho Cucamonga, California}

Not a day goes by where I don’t ask myself the following question: Should I, or shouldn’t I go to the gym today?

You don’t have to be lectured by a doctor to know that exercise is good for you. We all recognize that exercise provides positive benefits on our overall health and mood, yet do we religiously incorporate physical activity into our regular routines? Trust me, even as a physician who preaches the importance of incorporating non-medication alternatives such as exercise into wellness plans, I empathize with the struggle to prioritize physical activity in our busy schedules. Yet, if you’re interested in even more specific ways that exercise can enhance your mental health, I compiled a list of information that I often provide to my patients:

1. Target your mood. Exercise has been shown to be just as effective as antidepressants for the treatment of depression. A study led by Dr. James Blumenthal found that an exercise program provided equal benefits in mood as regular doses of Zoloft (a commonly prescribed antidepressant). Also, a Cochrane review (which is a systematic review of all high quality research relevant to a specific research question) found that exercise is associated with a greater reduction in depression symptoms compared with no treatment.

2. Alleviate anxiety. I can attest to this, for my ability to manage stress (especially when in clinic) declines after missing several workouts, though my coworkers say I mask my anxiety fairly well (which is hard for me to believe!). Aerobic exercise has been shown to be an effective treatment for several anxiety disorders. One study found that exercising at 70-90% of maximum heart rate for 20 minutes 3 times a week has been shown to significantly reduce anxiety sensitivity.

3. Boost concentration. Exercise elevates the brain’s levels of dopamine and norephinephrine, which are important chemicals involved with focus, attention, and our executive functions (planning, analyzing, prioritizing, organizing, initiating, and completing tasks/activities). Some people with ADHD are able to manage their symptoms with exercise alone, though many find the ideal treatment regimen includes medication plus exercise. For more helpful info, I often refer my patients to ADDitudeMag.COM.

4. Sleep better. Though the most common method utilized to treat insomnia is via pharmaceuticals, I am always on the lookout for ways to improve sleep without the risks of dependency and tolerance that many sleep aids have. Regular, physical exercise raises core body temperature, which can benefit the initiation and maintenance of sleep.

5. Improve heart health. People living with mental illness tend to have higher risks of cardiovascular disease. Over 50% of adults with serious mental illness are obese. Among individuals who are overweight, losing 5% of body weight can improve risk significantly and one way to accomplish this is through lifestyle modifications such as increased exercise.

6. Connect with others. Social connectivity has been found to be one of the factors that contributes to happiness and well-being. Whether you have a walking buddy, join an exercise class, or join a meet-up group for hiking, etc, physical activity may provide an opportunity to socialize and engage with others.

7. Sharpen your memory. Studies on exercise and prevention of dementia were mostly limited to studies performed on rats, but I did find one promising study which found that older adults involved in a 6-month aerobic training program positively impacted cognitive functioning.

I often tell my patients that they don’t have to be marathon runners to experience the benefits of exercise. The most important aspect to keep in mind when choosing your preferred form of exercise is sustainability — your chosen form of exercise should be something congruent with your interests, goals, and can be easily incorporated into your routine, whether it’s walking, running, playing basketball, yoga, dancing, etc.

Thought of the Day: Which type of exercise have you found to improve your mental health?

Photo by Marlon Santos

May 28, 2015 10 comments

Lifestyle Personal

Finding Balance

written by freudandfashion

{McDowell Sonoran Preserve, Scottsdale, AZ}

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

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

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

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

March 17, 2015 7 comments