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medicine

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

written by admin

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

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

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

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

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

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

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

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

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

References:

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

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

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

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

SpeakEndo

https://www.speakendo.com

March 30, 2018 0 comment

Medicine

Healthcare Lesson On a Plane Ride

written by freudandfashion

{Sacramento International Airport}

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

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

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

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

April 2, 2016 16 comments

Lifestyle Medicine

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

written by freudandfashion

{Napa, California}

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

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

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

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

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

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

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

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

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

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

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

Photo by Alex Manipod

January 8, 2016 38 comments

Medicine

5 Things I Would Tell My Pre-Med Self

written by freudandfashion

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

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

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

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

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

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

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

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

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

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

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

Photo by Marlon Santos

November 6, 2015 19 comments

Psychiatry

Steps I Take To Be A Stigma Free Psychiatrist

written by freudandfashion

It’s a busy week for raising mental health awareness. Today is World Mental Health Day (October 10th), which is a day observed for discussing issues, garnering support, and mobilizing efforts to improve the treatment and public attitudes towards people living with mental illness worldwide (this year’s theme is “Dignity In Mental Health”). Today is also the final day of Mental Illness Awareness Week (Oct. 4-10), which falls each year during the first week of October to recognize the efforts of the National Alliance on Mental Illness (NAMI) to fight stigma, provide support, and educate the public. This year’s theme is #IAmStigmaFree. As a psychiatrist, I wanted to utilize this opportunity to identify the steps that I regularly take to eliminate stigma in my practice. My process has required a lot of personal work — learning, self-examination, self-reflection, patience; and I acknowledge that I am still a work in progress. However, I want to emphasize that I am working on myself to ensure that my patients receive the best care possible because I know what it’s like to be judged prematurely based on others’ hurtful perceptions.

Our own misconceptions of people living with mental illness are reflected in our interactions. As a physician, I believe it’s important that my fellow colleagues especially be aware of how their actions and words impact patients (ie, anger, impatience, frustration, labeling, etc). Even mental health professionals can perpetuate stigma by not utilizing proper language nor acknowledging how our own stigma impacts the therapeutic relationship (to all of you who’ve ever looked at your patient schedule and uttered phrases such as “greatttt, another psych case,” or “oh geez, it’s that one guy again who can’t stop drinking,” or “she’s so borderline and difficult,” etc — YES, I’m talking to YOU). And again, I admit that I’m not perfect because I’ve mumbled similar phrases in the past myself. Therefore, the following are steps that I take in my own life to ensure that my patients feel understood, rather than stigmatized and judged:

Be open to changing your perspective towards mental illness
- As I’ve mentioned in previous posts, earlier in my training I was quick to label patients as being “non-compliant,” “agitated,” etc. A stark contrast to my current way of practicing, I didn’t allow proper time to get to know my patients beyond going through a checklist of DSM diagnostic criteria (though one factor may have been naivete as a “green” intern physician, the predominant factor was the influence of the broader society’s stigmatization of the mentally ill population). However, I noticed a drastic shift immediately after I switched residency programs and was introduced to a more humanistic way of practice (the way Psychiatry SHOULD be practiced), where my mentors immediately encouraged me to eliminate words such as “non-compliant,” “agitated” and to get to know patients for who they are as people, NOT just their diagnosis.
- I remember initially resisting my new program’s approach (mostly because I realized that it requires far more effort to be humanistic than it does to robotically rehearse a checklist of information and churn out medication recommendations based on symptoms alone, while minimizing any type of emotional connection with a patient), but welcomed the change in order to grow both personally and professionally.
- Note: For all the providers out there who feel there’s no time allotted in your jam-packed schedule to have empathy while seeing > 20 patients in one day, I feel your pain. The moment I realized the negative impact that being an overworked physician had on my interactions with patients, I decided to quit.

Separate my own issues from my patients
- When meeting patients for the first time, I admit that sometimes I’m exhausted from work and the last thing I want to do is meet a new patient because, in general, it takes far more effort to meet someone new than it does to see someone whom I’m already familiar with (this sentiment applies to social interactions in day to day life as well). I may start the session off feeling a bit irritable, however, once I start talking to my new patient, my anxiety settles (because I realize their anxiety levels about meeting a new doctor far exceed mine) and realize that my exhaustion and irritability interferes with giving my patient the attention he/she deserves.
- I recall the first time I met my psychotherapist and how high my anxiety levels were during session. How horrified would I have felt if my therapist was quick to judge me for reasons such as wanting to complete the interview within the the shortest time-frame possible rather than taking the time to get to know me? The moment that I identify my own anxiety brought to session when with a patient, I allow myself to relax, which in turn helps my patients feel more at ease as I proceed to ask not only my standard questions, but also thought-provoking questions about their lives in order to better understand them as unique individuals.

Learn and educate yourself
- When I first had a patient with autism, borderline personality disorder, eating disorder, traumatic encephalopathy, etc, I prioritized researching and gathering as much information as possible in order to better understand and help them. Oftentimes, stigma regarding a specific illness is propagated due to lack of willingness to learn and understand a person’s experience. If I want to fully understand what my patient’s experience with having a specific disorder is like beyond the literature, I ask them! I noticed that my patients appreciate when I ask because inquiring demonstrates that although I may not have firsthand experience with what they’re going through, I truly have an interest in wanting to know what it’s like to live in their shoes.

Be connected
- The first time I met someone living with mental illness was when my aunt, who has been diagnosed with profound intellectual disability and schizophrenia, came to live with my family when I was in my early teens. Rather than live in fear and avoidance of my aunt (fear and social distancing are contributors to stigma), I made a goal to connect with her on a regular basis (say “hello,” ask questions about her day, shake her hand, comb her hair, etc). Eventually, she warmed up to me and I appreciated her unique qualities such as her love for simple things (dog stuffed animals, a glass of water, sitting outside to get fresh air) and the rotation of her favorite phrases that she’d randomly blurt out (usually pertaining to wanting to visit the Philippines and her sister’s guide dog). Having the connection with my aunt taught me early on of the importance of looking beyond someone’s mental illness.
- Being active on social media also allows me to connect with mental health advocates and people living with mental illness. Outside of clinic, I find that reading their posts and being a part of the social media community provides a deeper perspective of their experiences as clinicians and consumers within the mental health system.

Share and teach others
- Sharing my experiences and advocating for a humanistic approach to psychiatry is exactly the reason I blog. I recall attending a meeting while working on an inpatient psychiatric hospital during residency and my supervisor yelled at the staff members for laughing at a stigmatizing quip made about one of the patients (staff members clearly felt ashamed and never made such comments during meetings thereafter). I admired my supervisor for standing up for the patients and from that moment on, I never tolerated stigmatizing remarks made in the various places I have worked. Sure, I’ve been the buzzkill during meetings in various clinical environments, but such comments should not be made in the first place. If I can change someone’s perspective and reduce the perpetuation of stigma, then I’ll keep advocating, buzzkilling, sharing, and fighting.

October 10, 2015 17 comments

Psychiatry therapy

Termination Point

written by freudandfashion

Saying “goodbye” can stir a variety of emotions including sadness, anger, and relief. The whole experience can feel quite uncomfortable, so is it better to say “goodbye” or to say nothing at all? Clearly, the more thoughtful and courteous action would be to leave with at least some type of acknowledgement (a wave, a handshake, the verbalization of “goodbye,” etc), though it might be less anxiety-provoking to slip away unnoticed.

In the context of terminating treatment in Psychiatry, there are various reasons why treatment between the psychiatrist and a patient may end:

a patient wishes/chooses to end treatment
the psychiatrist gets a new job, retires, or leaves the practice
the patient changes insurance plans
the patient moves
the psychiatrist passes away

For the sake of this post, I will focus on what I’m currently experiencing — saying goodbye to patients due to a new job. In this situation, the ending of treatment is not the patient’s choice, which can stir a combination of emotions such as abandonment, sadness, loss, betrayal, anger. Though some psychiatrists may feel that sending a letter or written notice informing of their leave will suffice (I won’t get into the complex legal aspects here), effort should be made to ensure that the patient does not feel at fault for the termination of treatment (ie, a patient may feel that the doctor is ending treatment because the doctor doesn’t like them, etc). Which is exactly the reason a termination phase (or at the very least, a final session) is crucial to help process emotions that may come up, allot a decent amount of time to coordinate transfer/continuity of care, and most importantly, to provide closure (for both the patient and psychiatrist).

In the last few days, I’ve experienced random moments of feeling sad and numb. Some of my followers on Snapchat may have noticed my absence of posts for over one week (I usually post on a daily basis). My videos are generally motivated by something exciting from my day or a psychiatric tidbit of knowledge that I wish to share, however I haven’t been as inspired lately. Even while writing this post, I’m interrupted by moments of abruptly staring into space and my mind wandering to more superficial thoughts such as shopping, what to make for dinner, and celebrity gossip.

With only a few weeks left until my final day in clinic, I fight the urge to flee and avoid the discussion of termination. But then I refocus and put my psychiatrist hat on and consider the potential impact that avoidance of the topic may have on my patient. However, the professional aspect of fulfilling my duty and ensuring proper transition to another provider for continuation of care is the easier part. The more difficult aspect is letting go of the strong connections that I’ve built with my patients, especially those who watched me grow from a newbie psychiatrist straight out of residency to one they grew to depend on and trust.

Despite the complex mixture of emotions, I know that I’m doing what’s best for me personally and professionally by taking this next step in my career. Yet, if I’m having a tough time, imagine how my patients must feel.

September 10, 2015 10 comments

Personal Psychiatry

Look You In The Eye

written by freudandfashion

Several friends have pointed out to me their observations of my interactions when in public places: that people strike up random conversations with me, ask for directions, of if I could take a couple’s picture at a touristy hot spot, etc. These types of interactions are becoming less awkward to me in the last few years, and I initially attributed my approachability to giving off a “psychiatrist” vibe, as if people can sense that I’m trained to listen to people’s issues. Or, perhaps, as one friend pointed out, I appear to be the antithesis of “bitchy resting face” syndrome.

Flashback to around twenty years ago when I was a loner preteen in the girls’ locker room, where my locker was located in the same aisle as the most popular girls at my school. As I stared at the floor too shy to make eye contact, I recall trying to muster the courage to say something to them…anything…in hope of some kind of acknowledgement, a wave, even a “hi” — anything to feel slightly less invisible than I already was. When I looked up directly towards them, words never left my mouth. All I had the courage to do was smile. A forced, awkward, and uncomfortable smile that caused my cheeks to fatigue.

And all that effort and energy exerted for the end result of coming off as creepy: “That girl is smiling too much,” was all they said. From then on and for quite some time, I became known as “that weird smiley girl.” As if smiling was a negative thing. And, as one could imagine, I didn’t smile for months thereafter. Little did they know how much of a hit to my self-esteem that one incident would have. Putting yourself out there only to get rejected sucks and may hinder further attempts to connect with others in the future.

One may perceive me as a highly sensitive, socially anxious person, and I don’t deny possessing those traits. However, rather than being identified with a label or descriptor (ie, “That weird, smiley girl” or “Vania is anxious and highly sensitive”), I prefer that people acknowledge the different facets of my personality that make up who I am as an individual (ie, “Vania has social anxiety and can be sensitive”). The general tone changes depending on the wording and language used. In the former statement, being “anxious” and “highly sensitive” are inferred to be words that define me, whereas the latter refers to “anxious” and “highly sensitive” as traits.

For many years, I viewed myself as abnormal. That is, until the last few years where I grew to appreciate the qualities that make me who I am as a unique individual, which I attribute to surrounding myself with an amazing support system, including my therapist, who helped me realize it. As a result, I no longer stare downward nor feel afraid to smile and chat with others.

An issue that I have with how Psychiatry is perceived is the tendency to create labels. Many people have enough anxiety about seeking psychiatric help in the first place, and the fear of being labeled and stigmatized might sit at the top of one’s list of concerns. I’ve encountered several patients who told me they were diagnosed with a specific mental illness after one brief, initial 30-minute interview. “The doctor told me I’m Bipolar without barely getting to know me” is a statement of different variations that I’ve heard several times in my practice. I try to maintain an open mind about my colleagues, especially those who are only allotted 20-30 minutes to meet with a new patient (which is ridiculous in medicine, especially in psychiatry) because the ability to see a high volume of patients within a short time frame AND fully get to know each patient seems unrealistic and virtually impossible to maintain.

However, the last thing any person, including any medical provider, should do is make you feel like another label and essentially invisible or judged. Often when people muster up the courage to reach out and seek help are in times of desperation and in highly vulnerable states. The most therapeutic thing any person (or provider) can do is look you in the eye (even if you might be too afraid to look directly at them) and acknowledge you for who you are.

September 2, 2015 8 comments

Medicine Psychiatry

The Other Side

written by freudandfashion

Written on August 11, 2015

My psychotherapy supervisor taught me a tip during residency — to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session (because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning). I struggled to come up with a topic to discuss on my blog today. At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that didn’t seem quite appropriate to post today. I try my best to ensure that my blogposts are reflective of my current state of mind, and my current mood is actually quite solemn.

I know that today marks the one-year death anniversary of Robin Williams, yet avoided news articles, tweets, and Instagram posts that paid tribute to the iconic, inspirational actor. While sitting on the couch and staring blankly at the television screen, a short reel of Robin Williams popped up on entertainment news. Not content with the mainstream, flowery piece which strung together brief clips of some of his finest, Oscar-winning work followed by a quick moment of silence in remembrance, I picked up my phone. While scrolling through Instagram, I focused on a long, detailed post written by a young man in which he describes his own personal battle with depression and multiple, near fatal suicide attempts. Robin Williams’ lost battle to mental illness motivated this man to share his story rather than isolate in shame and silence. The words authentically describe the powerless experience of succumbing to the disease. The depression takes exclusive command and overrides any attempt at rationalization. And I know the story to be true because the writer is a dear friend of mine who miraculously survived.

Several of my patients have described similar experiences. Several people living with mental illness whom I follow on social media share similar stories. Every morning that I arrive in clinic, I log on to my electronic medical records and pray not to see a message from the coroner’s office. As a psychiatrist, getting that dreaded phone call from the medical examiner is probably my equivalent to the oncologist receiving a call from a family member or hospice staff. As a young teen, I vividly recall accompanying my family for routine, frequent visits to my grandparents’ apartment, where my grandfather passed away, rid of the suffering he endured from colon cancer. A few years later, my grandmother peacefully died from multiple myeloma. Her last words to me before she passed was that she wished for the opportunity to pay for my education and witness me become a doctor. My other grandfather, as he approached the end stages of his battle with cancer, fulfilled his wish to fly back to the Philippines, where he comfortably spent his final days in his homeland with our large, extended family by his side. When the medical examiner’s call ends, my immediate response is to shut the door and sit alone in silence.

Finally recognizing the mixture of emotions that I suppressed the entire day, I could no longer hold in my tears. Rather than isolating (as clinicians tend to do when it comes to coping with patient loss), I attempted to share my thoughts and emotions on social media, with the goal to make others aware of the difficult emotions that we, as mental health practitioners, face when dealing with patient suicide. The loss not only permanently impacts us professionally in our practice, but also as human beings. I left the post on my feed for 20 seconds, then immediately deleted it. Shame, embarrassment, and fear of judgment overrode my hope to break the norm of silence and connect with others too afraid to open up about their own experiences losing a patient to suicide.

As you can see, I waited a few days to publish this post after much contemplation. The truth is that the fear of losing a patient to suicide weighs heavily on my mind almost every day.

August 13, 2015 16 comments

Medicine Psychiatry

The Drug Rep Dilemma

written by freudandfashion

I attend pharmaceutical dinners every once in awhile because: 1) I like to stay up to date with all the new drugs (or just a slightly modified version of the generic, but with a much fancier name and packaging); 2) Though I’m several years out of med school/residency, one thing I have maintained from those formative years is the mentality where I’d never pass up a free meal. I know that pharmaceutical sales representatives (also known as drug reps) have been banned and limited in several institutions, and I completely understand the reasoning (it has been shown that drug reps’ marketing tactics influence physicians to write prescriptions they typically would not write, thus boosting pharmaceutical sales). However, I also think it’s important for physicians to be self-aware of their existence and influence in order to make conscious decisions on their own.

A few months ago, I attended a pharmaceutical dinner sponsored by the manufacturer of one of the newest psychiatric medications. These dinners always feature a physician, who describes the medication (the pharmacology, indications, side effects, etc), explains the existing research in support of the medication, and leads a discussion and answers clinical questions. My initial impression of the night’s presenting physician: charming, and since his introduction boasts the research he conducts at a prestigious university, he must be highly reputable and intelligent. But, as his talk progressed, I realized how narcissistic and full of sh** he was. I sat in the very front, yet chuckled to myself and assumed every other clinician in this room picked up on his suave, yet unconvincing tactics. I mean, who was this guy trying to fool by flaunting his European accent and stories of trips around the world??

However, I looked around the room and the entire audience of doctors and other clinicians were laughing and smiling in awe. I tried to hide my disdain and cringing facial expressions, but I sat at the very front of the room, so I’m sure others noticed. Or maybe not…I mean, everyone in the room was mesmerized by this guy! I figured that I should refocus my thoughts and give him another chance and caught up just in time to hear about his trip to Europe. I shook my head and thought to myself, “wow, can you believe this guy? And he gets paid tons of money to attend this dinner and talk about himself?” I smirked and assumed his current, pointless story-telling (aren’t we supposed to be discussing the medication?) would be convincing enough to prove his bullsh**, fake persona, so I turned to look at the audience assuming others would catch on. Still, all smiles.

At the end of the dinner, I found myself in a dilemma as I had to pass this man on my way out as I left the dining room. I contemplated whether I should act just as fake as his schmoozing and say something along the lines of “hey, great presentation” or should I challenge some of the comments he made? I settled for a more neutral comment and told him “thanks, you are very entertaining” as I shook his hand and smiled.

Then, I realized at that very moment I became just like everyone else in the audience who commended and complimented him. For a temporary, quick second I even contemplated prescribing the medication. The thought of prescribing the medication was short-lived, for, after I left the restaurant, I snapped out of it and wished I gave him a piece of my mind.

I thought, “oh well, instead I’ll just stick with my guns and won’t be overly influenced to prescribe the med, unless clinically indicated.” (I’d never deprive my patients of a medication that might possibly help). I now realize even more why pharmaceutical companies used to frequently provide fancy trips, extravagant dinners, and expensive novelties before policies/rules became more stringent. The speakers and drug reps can be quite hypnotic and mesmerizing, but it’s our duty not to be fooled by any marketing tactics.

Or have I already been swayed?

July 2, 2015 11 comments

Psychiatry

Psychiatry Specialty of Choice

written by freudandfashion

{Miami Beach, Florida}

Though I graduated from psychiatry residency three years ago and am fully employed, I continue to receive email notifications and phone calls about Psychiatrist job openings on a daily basis. Though I typically get annoyed by the regular phone calls and messages, a part of me feels thankful that I have a lucrative career in such high demand with job openings readily available if needed, however, a part of me also can’t help but question why there’s such a shortage in psychiatrists to fill the positions. I wrote a previous post on reasons why Psychiatry is an amazing specialty to choose, but if any current premed or medical students have any questions/concerns about the field of Psychiatry, I’d love to connect with you and answer any questions you may have. The field of Psychiatry is extremely rewarding and I’d do anything I could to promote it because there’s so many people in need of psychiatric services.

Thought of the Day: TO ALL PREMED, FUTURE DOCTORS, & MEDICAL STUDENTS — Is Psychiatry on your radar as a possible specialty? And if not, would love to hear the reason why as well! Comment below or email me at freudandfashion@gmail.com.

June 11, 2015 10 comments

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