The first analysis we will be reviewing is an overview of stress in medical practice, which allows the reader to get a general overview of stress. Stress can be defined as an undue, inappropriate or exaggerated response to a situation. Anxiety about a situation could be positive, but stress is always negative. The adverse psychological changes can actually decrease productivity. This stress in medical practice is simply due to the fact that medical service involves taking care of other people's’ lives and that mistakes or errors could be costly and irreversible. With this aspect of medicine being so highly valued, it is expected that the medical doctor himself must be in a perfect state of mind, without the morbid worries and anxieties. However, doctors are affected by same variables to impose stress, but also prone to stress because of their own work situations and societal expectations. The British Medical Association (BMA) published a treatise on stress in junior and senior doctors. The conclusions were that the effect of stress was similar in both groups and obstructed the doctors’ health and service delivery to patients. Other studies from the American Foundation for Suicide Prevention, show that on average death by suicide is 70% more likely among male physicians than any other professions and 250-400% higher among female doctors, caused by stress and depression. Social expectation, training, and a hostile job environment all factors that contribute to these terrifying statistics. Similar to other professions, there are societal expectations for a doctor. For example, doctors are supposed to be a comfortable person as they are financially well off and failure to meet this expectation can lead to eventual depression. The training for becoming a doctor itself is extremely strenuous, with just getting into the undergraduate and postgraduate levels requiring students to pass through the eye of a needle. A hostile job environment is also very common within the medical field, one that is created by administrative ineptitude and bureaucratic bottlenecks that make the job harder to get though. These issues caused early on in the medical journey can be materialized through individual behavior of increased alcohol consumption and smoking. However, these effects can also be seen through the mental toll that can lead to intense seclusion and individualism. This compromises the quality of care and can lead to impairment of health, grief and suffering.
The second research study we will be looking at is a report on how doctors have managed to deal with difficult patient encounters. Starting with some statistics, it becomes seemingly clear that the number of patients that are “difficult” is so high that even we, as patients, could be included in it! 15% of patient-physician encounters rated as difficult. This difficulty could be caused by patient characteristics like depression or anxiety disorders, somatic symptoms, and greater symptom severity. Physician characteristics that can affect how difficult they see patient interactions are their attitudes about care, fatigue, stress, and burnout. When patients are angry, defensive, frightened, resistant, physicians have to uncover source of difficulty for patient and pay attention to how emotions relate to the medical issues at hand. All of this must be done without getting drawn into a conflict. Patients can also be manipulative and play on guilt of others, threatening range, legal action, or suicide making it all the more difficult to distinguish between personality disorder and being manipulative. With patients like these, physicians must be aware of their own emotions and attempt to understand what the patient wants to get from their care. Two things that physicians must be prepared to deal with are the normal stages of grief and how to break bad news. In terms of grief, doctors must evaluate its cultural context and learn how to validate the patient’s experience with grief. When you are breaking bad news, it is imperative to know who will be present, allow adequate time, privacy, and review clinical situation. Though this is a very personal experience and doctors each have their own way with how they choose to do this, this study recommended disclosing the news directly, allowing adequate response time, discussing implications, having additional resources ready, summarizing discussions, and arranging for a follow-up. This is the final blog and truly gives us enough information to see why the relationship between a doctor and their patients and the relationship between a doctor and their own emotions are equally important in the medical field. Before choosing to become a doctor, people should be aware of the aforementioned and evaluate themselves based on how effectively they can execute these relationships. CHECK OUT THE STUDIES: www.ncbi.nlm.nih.gov/pmc/articles/PMC2408543/. www.aafp.org/fpm/2007/0600/p30.html .
0 Comments
The first source we will be reviewing is from Jennifer Adaeze Okwerekwu but is more of a personal journal of how becoming a doctor has taken a toll on her mental health. She starts by saying that practicing medicine requires discipline, dedication, and sacrifice and that is truly not compatible with social and emotional needs as humans. She cites an example in her own life. A fellow resident in another program said after a long and stressful day simply pulled over on the highway to just cry, as she didn’t want to cry and drive at the same time. This is just an isolated example of the materialized effects of simply being a physician. 400 physicians die by suicide each year. As the medical profession stars, this directly leads to an increase in burnout and depression. The signs and symptoms are all around. Another friend had a terrible residency experience that taught her how strong and confident she could be. Being a physician allows people to learn from adversity and grow as a result of the challenges they face. However, these experiences still makes many question how much more she could have blossomed as a physician if this growth was driven by support, not survival. From this perspective medicine is best and worst thing: survived extremes of loneliness, anger, humiliation, or sadness, but, in the end, you reap the benefits of simply being a doctor.
The next source we will look at is from the opinion column of the New York Times, attempting to answer the question, “Why Do Doctors Commit Suicide?”. The piece starts with an example of 2 medical residents in second month of residency training in 2 different programs that jumped to their deaths in NYC. But, the most important takeaway is that these 2 started with the same enthusiasm for healing as everyone else. The fatigue, emotional exhaustion, and crippling self-doubt they experience at the start of their residencies was too overwhelming. The statistics on physician suicide are dreadful. Physicians are more than twice as likely to kill themselves as non physicians and female physicians 3 times more likely than male counterparts. Young physicians are more vulnerable, with 9.4% of fourth year medical students and interns reported having suicidal thoughts in previous 2 weeks. Hospitals and residency programs recognize the toll residency takes on the mental stability. Efforts and steps are being taken. In 2003. work hours were capped at 80 hours a week. Many hospitals offer confidential counseling services to cope with stress. Despite these efforts, people can still fall through cracks. The social social isolation, substance abuse, and other aspects of medical culture might push troubled residents beyond their reserves of emotional resilience. Even though society recognizes that these emotional tolls come in conjunction with medicine, there is still a strange machismo that pervades medicine. The pressure to project intellectual, emotional and physical prowess, causing many to masquerade as strong and untroubled professionals. This prevents most from being able to identify colleagues in trouble. We can see a darker aspect of the identity of a doctor. These sources actually reveal something further about what specific emotions are attached to this identity. We can see that doctors have to find an effective way to deal with the stress and death that they are surrounded by in just their workplace. This blog specifically aids the understanding of the purpose of this blog, as it becomes clear that people who want to be doctors should be fully aware of what they are getting themselves involved in. CHECK OUT THE STUDIES: https://www.statnews.com/2016/09/19/mental-health-doctor-residency/ https://www.nytimes.com/2014/09/05/opinion/why-do-doctors-commit-suicide.html The first study that we will be analyzing in this blog was created by Randy and Lori Sansone who compiled many different research pieces about physician grief and analyzed each one. Both authors are MDs. They report that grief-related jobs and stress may culminate in job related burnout and this can be seen most clearly by seeing that this burnout affects up to 50% of physicians treating the terminally ill. Authors from another study state that physicians often experience grief because of deaths of patients. Though this may seem obvious, a qualitative study by Rhodes-Kropf interviewed 65 3rd year medical students from 2 schools about emotional reactions to patient deaths. The final analysis from the 32 interviews examined showed that 57% rated effect of patient death as highly emotionally impactful; 63% said no discussion by colleagues of the experience in aftermath of death. A Sullivan USA study showed that ½ felt unprepared to manage their emotions about death. 188 Medical personnel in 2 academic teaching institutions that Redinbaugh examined participants’ reactions to the recent death of a patient showed that women participants and physicians who had cared for the patient for a longer period experienced stronger emotions. ¼ that did end up speaking to their attending physicians found this experience not helpful. A study conducted in Scotland by Linklater examined 79 physicians that were frequently exposed to patient deaths said that 61% said most memorable death was emotionally distressing and 26% said recent personal bereavement was worse. Moon suggests that if physicians participate in death talks, increase social engagements that examine the complex dynamics of grief, and emphasize importance of adequate grief support, we could see a difference in how physicians actually deal with grief.
The second study is a research paper from Stanford that actually identifies the relationship between a doctor and patient and why patients might be inclined to like a certain doctor. The first precedent that is set is the idea that a strong emotional connection between how a patient ideally wants to feel and the doctor they choose makes it more likely that the patient will follow their doctor’s advice. According to Stanford Psychology Associate Prof Jeanne Tsai & Tamara Sims who is a postdoctoral fellow at Stanford, after examining the patient-doctor relationship thru 2 emotional states excitement and passion and calmness and relaxation, they realized that how people wanted to feel predicted the physicians they chose. For example, 101 San Francisco Bay Area adults answered questions about their health and ideal ways of feeling good and then watched videos which emphasized positive states in how they communicated. Then, the test subjects received feedback from physician and same list of health recommendations. After 5 days, participants reported on whether they actually engaged in these recommended behaviors. The results were that patients were significantly more likely to listen to doctors when they fit ideal expectations. This allowed the researchers to come to a generalized solution that doctors need to evaluate patients’ ideal effect. We, as humans, already recognize that people differ in certain type of values but can be ignorant to the fact that people can also differ in emotional values. Both of these sources have an underlying idea that captures the relationship between a patient and their doctor. Though we have explored this connection before, these 2 studies explain how this relationship can manifest and the effect it has. The first study exemplifies the effect that a patient’s death can have on their doctor solely because of the importance of their relationship. The second study talks about how this relationship can actually form that has a direct correlation to the “identities” that one has on what they value emotionally the most. CHECK OUT THE STUDIES: www.ncbi.nlm.nih.gov/pmc/articles/PMC3366454/. http://news.stanford.edu/2015/04/02/doctor-patient-emotion-040215/. The first paper we will be looking at was a paper that was written and then reviewed by somebody who knows a lot on this subject. The main focus of the report is to evaluate how pediatricians deal with the death of a child. They talk about some of the emotions that are felt by pediatricians, as they point out that not enough information was previously published on this subject, meaning this report had to work from scratch. The paper then described one of the biggest emotionally traumatizing experiences a pediatrician can have, the SUDDEN death of a child. It causes shock and self-doubt, especially when this is a newly-minted doctor. When a child dies, the first response is to question their own quality of care, creating a sense of uncertainty that can last for long periods at a time. If mistakes are found to invoke substandard care, it can lead to severe emotional reactions, regardless of seniority. The most common and dangerous result of having emotion experiences in the medical industry is that doctors can begin to personalizing and internalizing the tragedy, which tends to affect how they treat their own family.
This leads to something we’ve talked about before, externalizing the problem. In one of the previous sources we’ve analyzed, it was stated that doctors use humor as a coping mechanism to deal with the difficulties they deal with in the workplace. This can be generally labeled as externalizing the problem and becoming numb to emotion. There is currently no agreement on what is the best way to provide support for doctors. Currently, the most popular way to do this is through psychological debriefing, which is a technique used to mitigate long term consequences of exposure to increased stress. However, that method is currently being questioned. With a lack of research on this subject as a whole, many find it difficult to asses what is the best solution to the problem. This report ends with a simple solution of getting more and/or better training in medical school itself, to prepare people for the realities to come. The second study also focused on a specific specialty, oncology. This is another field of medicine that has a large amount of patient loss involved. However, even physicians like these are subject to the taboo on the idea that emotion itself can have a negative consequence on both the doctor and the quality of care they produce. This was conducted at 3 Canadian hospitals from the years 2010-2011, with 20 oncologists who varied in age, sex, and years of experience. The data was analyzed by a systematic coding transcript that searched for themes. When looking at the results, it was clear that oncologists struggled to manage their feelings of grief with detachment they deemed necessary to do their job. Half of the participants reported feelings of failure, self-doubt, sadness and powerlessness and one third talk about feelings of guilt, loss of sleep, and crying. Another finding is that grief leads to inattentiveness, impatience, irritability, emotional exhaustion, and burnout. However, they hid these emotions from others because showing emotions is considered a sign of weakness. Participants reported that they fear their discomfort with grief over patient loss could affect treatment decisions with future patients. For example, they could avoid diagnosing more aggressive chemotherapy, or in a clinical trial. This uneasiness with losing patients could potentially affect doctors’ ability to communicate about end-of-life issues with patients and families. Participants also said they distanced themselves and withdrew from patients as patients got closer to dying. These sources are important to see what specific situations put a strain on the doctor-patient relationship. They especially show us how this strain has a unique effect on the doctor and stress the fact that doctors are in fact human. In previous sources, doctors seem to have a different response to pain and can approach stress differently, but these sources show the reader that they do need the same caring that any other person would. CHECK OUT THE STUDIES: www.ncbi.nlm.nih.gov/pmc/articles/PMC2082912/. www.nytimes.com/2012/05/27/opinion/sunday/when-doctors-grieve.html?mcubz=1. This first source that we will be analyzing is a radio interview with author Danielle Ofri, about her newest book. Danielle Ofri is a doctor at New York's Bellevue Hospital and teaches at the New York School of Medicine. The book is an account of what experiences she has had as a doctor and what she personally believes the future of medicine should look like. The first thing she talks about is how medical schools can teach students to keep their emotions in check. Similar to most doctors, she also believes that emotions can cloud your judgement, including having an effect on both general professionalism and specifically the doctor-patient relationship.
The biggest thing that she addresses is how humor is used in the medical field as a coping mechanism. In the real world, doctors use humor as a way to access emotions, usually at the expense of patients. However, there are some “established” rules of humor. For example, it is considered acceptable to joke about alcoholics and drug addicts, but it’s not okay to joke about those with cancer. Some doctors believe that communication without any emotion is not the correct way to teach medical students, because many patients obviously prefer a caring, empathetic, human. She believes that is necessary is that doctors should get counseling for their emotions, the same way psychologists and psychiatrists get counseling for dealing with emotionally draining patients. The second thing she recommends is that supervising doctors must teach their students how to connect with patients better. Unless we begin enforcing this in students at an early age, it will be extremely difficult to expect this out of them later. The second source we will be analyzing is focused specifically on understanding the psychology behind physician attitudes and behaviors. This journal started with introducing something that Malcolm Gladwell said at the National Medical conference in 2008. He talked about the duality of being a doctor, the productive, personal side, that is rewarded by a mission driven spirit, and the conflicts that generate the impersonal side of healthcare, which affects physician attitudes. Over the years, physicians have become more frustrated with medicine. They refuse to focus on developing personal skills or team collaboration mechanics, which leads to a decrease in sensitivity and emotional intelligence. This problem is exacerbated by the health care system by setting boundaries. Studies show that more than 50% of physicians report a significant amount of stress. This increased stress and burnout can lead to more irritability, cynicism, apathy, fatigue, and serious depression. Many physicians ignore this stress and simply accept it as part of the job. Physicians soon become reluctant to ask for help due to risk of competency, confidentiality, and blow to ego. Let’s now take a look at how this can connect to the original purpose of this blog itself. How does knowing this information allow us to understand the lives of physicians? By seeing the realities of what a doctor has to go through on a daily basis, it makes it clearer how their lives function. In Danielle Ofri book, she clearly outlines how physicians cope with the difficulties that lead to stress. By expanding our view and outlook on the lives of physicians, it can be clearer for people who want to be doctors whether that is actually the right path for them. CHECK OUT THE STUDIES: http://www.wnyc.org/story/300739-emotions-doctors , http://medcraveonline.com/JPCPY/JPCPY-05-00312.pdf We are going to be discussing 2 different studies that were both under the general umbrella of emotion and pain in the medical field and how physicians react to it. The first study that we will look at is a study conducted by the University of Chicago and the Institute of Neuroscience in Taipei. It was used to determine a physician’s response to pain. Jean Decety, who is the Professor of Psychology and Psychiatry at University of Chicago described the situation by saying that because doctors often have to inflict pain as part of the healing process, most develop the ability to not be distracted by suffering. Doctors learn to keep a detached perspective, which seemingly prevents them from getting extremely overwhelmed or stressed, which could eventually impair assistance to patients.
The study analyzed 2 groups, 14 physicians and 14 regular people, who were all tested with a functional MRI. Both groups watched videos where people were pricked with acupuncture needles and then Q-tips, and the video clips were shown in random order. Since research shows that the neural circuit that registers pain is also activated when we see another in pain, they focused heavily on watching this part. When they looked at the regular people, it was clear that the portion of the brain related to pain increased in activity and was under extreme duress during this experiment. However, in the physicians, there was no increase in the activity of brain related to pain. Interestingly enough, there WAS an increase in activity in cognitive control and emotion regulation, which are the frontal areas of the brain. In the end, these results were accounted for by explaining that the mechanisms involving empathy cannot overlap too much between others and yourself, which leads to a personal stress aversive reaction. If you let go of your own emotional concerns, it frees up the processing capacity for sake of the other. The next study that we will be analyzing was conducted at the Jefferson Medical College. 456 students who entered during the years 2002 and 2002 were given the Jefferson Scale of Physician Empathy test at 5 different times of their academic time at this school. First, on orientation day, and then at the end of each academic year. The analysis showed that empathy scores did not change significantly between years 1 and 2. However, in year 3, there was a significant decrease in empathy scores that began a slippery slope that continued until graduation. Across different specialities and genders, patterns of a decreasing score were similar. The authors of the study highlighted the irony that the largest erosion of empathy occurs when the curriculum is focused around patient care. When addressing why this was happening, the authors looked towards several factors. The first being a lack of role models, meaning that other doctors with authority were also exuding a loss of empathy. They also credited it to the stress that most medical students are under, with the high volume of material to learn and pressure of time itself. The study points toward the reality of the ideologies that medical schools promote, like emotional detachment, effective distance, and clinical neutrality. They finally address that students today no longer see the value in the humanistic side of medicine, and just want to get the diagnosis right. CHECK OUT THE STUDIES: http://www-news.uchicago.edu/releases/07/070927.decety.shtml http://journals.lww.com/academicmedicine/Fulltext/2009/09000/The_Devil_is_in_the_Third_Year__A_Longitudinal.12.aspx |
AuthorFeel free to contact me using the contact page! |