Changing the Culture of Mental Health Stigma in Healthcare

From the time undergraduate students start taking their pre-medical courses such as introductory biology, organic chemistry, biochemistry, and others, there is unfortunately a deep sense of competition that can often overpower even the kindest of souls. This is understandable as gaining admission to medical school continues to become more and more competitive. However, even from this stage, an inappropriate, dangerous, and maladaptive sense of machismo is infused in those hopeful to earn an MD or DO down the road. Bear in mind this is just my humble opinion as someone who has gone through the process to apply to and graduate from medical school in the United States. I certainly am not saying that all pre-medical students are the same, but if you were to ask most how they view themselves and their peers, you will hear similar tales and reflections.

Instead of focusing their efforts on mastering the content and collaborating on quality public health initiatives or research projects, many pre-medical students nervously eye one another during their group activities and lab sessions. I did not feel comfortable expressing my true self because there was this illogical fear that if I expressed my emotions, my anxiety about the process, that I was showing weakness. I quickly found that in my case, I could not sustain this inhuman sense of confidence, superiority, or complete lack of self doubt.

When I arrived in medical school I was shocked to find that things were even worse. Every other person around me was exhibiting signs of almost primal like competition. Along with this attitude of needing to prove oneself to be the best, to impress the supervising physicians and researchers who taught our preclinical courses, it become apparent there was a facade of 100% strength and fortitude that the majority of those around me displayed. An unspoken culture of repressing any emotional or spiritual issues we might have regarding what we were learning developed and was perpetuated. It was taboo to discuss our feelings regarding our patients except in the confines of late night conversations with our best friends. Even then, we were all nervous, somehow. Imagine – training to be a physician, tasked with being a healer and guide to others toward better health, yet we ourselves expected to maintain some kind of fortitude few if any could.

Here’s the reality, after 10 months of being a physician.

I do have doubts. I wake up every day wondering whether I have made the right decisions. Often I go to bed wondering whether the choices I have made that day, which today impact my patients and their health, were the right ones. I question my judgment on a minute to minute basis. I seek help when I am not sure of what is best. I have learned that without accepting that I am human, that I am allowed to experience uncertainty, I will not only be unhappy but I will endanger my patients.

I think that it’s important for physicians to break down the culture of stigma around mental health ailments and depression perpetuated across the generations. I have heard time and time again from seasoned physicians of all kinds with gray hairs purporting wisdom that “In my day, you would have been deemed unfit to treat patients!” Scary is an understatement.

You could identify many issues with health care today. Out of the grave financial and ethical burdens we face as a society all the time, quite a bit of the issue lies in the way we train our future physicians. How can we expect a young physician who is expected to never feel emotion, never express emotion, never exhibit signs of depression or even the slightest emotional response, to be emotionally supportive to his or her patients? How can we expect physicians, who are some of the worst at perpetuating stigma about displaying “emotional weakness” or seeking help for mental health, to continue to bear the weight of their calling day in, day out, without breaking?

Recently, a nurse, mother of two boys, and paramedic who I follow on Twitter, Jess Morton, delivered a talk at a Paramedicine conference entitled SPANZ16 on the issue of mental health stigma among care givers. I am eagerly awaiting the video of the talk and will link here when I have access. From what I followed on Twitter, the talk was well received and applauded. It was so wonderful to see an individual with experiences such as Jess deliver a talk on such crucial topics. I hope that as time goes on, we in the medical profession incorporate more and more discussion about mental health wellness and breaking down stigma for those who need and seek help.

We need more doctors, nurses, paramedics, EMTs, nurse practitioners, and physician assistants to speak out and break down stigma around mental health. It’s time that we dropped the facade. It’s time we stopped chastising care givers who themselves need care. We should welcome and celebrate honest and respectful discussion among those who deliver care in our health care system. In fact, it must be a priority to break down stigma surrounding mental health and wellness for everyone, regardless of who they are or what they do.

 

Doctor, It’s Okay to Cry, Part 1

Preface: I am planning on starting a series for young trainees of all kinds, including physicians, nurses, physician assistants, nurse practitioners, Emergency Medical Technicians, patient care technicians, and Paramedics. The purpose of this series is to share what I have learned along my journey so far, and what I continue to learn for the rest of my career in Medicine and Emergency Medicine. Please be patient with me as I work out the formatting, organization, and schedule for these posts. I felt this was an important topic and decided to start with a post addressing mental health among trainees, and those who deliver medical care. This is the start of my blog post contributions to #TipsForNewDocs. I welcome any and all comments, feedback, and hope that you may be inspired to share your experiences and join in allowing the medical community to feel empowered to share and process their experiences and emotions.

Note: Please be aware that the contents of this blog post contain descriptions of patients and their health conditions which may be graphic or upsetting to certain readers. In order to protect patient privacy I have kept things as general as possible, changed some of the situations around to protect those involved, and I hope you all understand the purpose for this post and do not dwell on the specifics. The specific patient situations are simply what I have observed, but all in health care will have their own stories.

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Many of you will recognize the photo above. It went viral last year after it was posted on social media by a friend of the physician posted in the photo, by permission. For those of you who are unfamiliar with the photograph and the story behind it, I encourage you to review this post which synthesizes the events that transpired and the background of this quite well.

This photo, and the story behind it, resonated with me so much when I learned about it. All my life, I had been known by family and friends to be emotional and attached to those around me. I knew going into medicine what was in store for me. That being said, it hasn’t and doesn’t make it any easier for me to deal with bearing witness to the suffering and loss that I do on a daily basis in my line of work.

I wanted to share some personal patient encounters that troubled me and caused me grief and emotional suffering afterward, because I think it is important we allow physicians, nurses, physician assistants, nurse practitioners, patient care technicians, and all those who participate in patient care, to experience, process, and truly be open about how they feel.

The first time I really cried after starting medical school was when I was a fourth year medical student. During one of my away rotations in an Emergency Department, I helped in the care of a police officer who was shot in the line of duty. I had assisted with and observed innumerable trauma resuscitations by this stage of my training, so the actual events transpiring in front of me were not unfamiliar to me. However, what was different about this situation, the first time I was directly involved in caring for an officer who was injured, was the sheer emotion of the situation. The officer’s colleagues flooded the Emergency Department. There was a complete different tone of urgency among the supervising attending physicians and trauma surgeons. I could see in the eyes of the nurses, technicians, physicians, and officers around me, that this was hurting them. The pain and suffering the policeman was enduring, the treatment that he was receiving, it was causing a tidal wave of many emotions throughout the facility.

There must have been 15 police cruisers that showed up outside of the department within moments of the officer’s arrival. Several of his lawmen had brought him to the department in their cruiser, since there was concern that by the time an ambulance arrived, the officer would be too sick to save. This was one of the first times I learned that in some situations police officers, because of the environment they served in, had to transport patients with trauma to Emergency Departments in their own cruisers. Not many people know this about police officers, and with the recent negative publicity that surrounds law enforcement all over America, I wish it to be known that police officers do so much that the news media never shares. They are, in many ways, endangering themselves day in and day out, for the general benefit of the citizens they serve. Bad apples always exist, and create negative publicity, but please do not forget what the men and women of America’s law enforcement agencies signed up to do for us – protect us.

The officer was rushed to the operating room, and there was silence in the Emergency Department. For anyone who has ever worked or been in any ED for any period of time, even as brief as 30 seconds, there is never silence. If an ED is quiet, you should worry. It took a good 30 minutes for the entire department to shake the effects of the trauma resuscitation. Staff, patients, officers who lingered behind for a time, appeared dazed. You could see some were emotional, but most looked stoic.

I went about the rest of my shift as usual and went home. It wasn’t until several days later that I realized how much this had affected me. I was watching The Wire with my wife (SPOILER ALERT) and watched an episode in which an officer was shot. In the make believe show, the officer was transported to Shock Trauma for resuscitation. I immediately and suddenly burst into some of the most awful crying I have ever done in my life. It rivaled how much I cried when I was kneeling besides my dying grandfather at home, who was on home hospice for his bad lung cancer, and whose hand I held as the last glimmers of life left his eyes. As I write this, I am fighting back the desire to again cry, because I happen to be writing this in a public space.

My wife held me close, and comforted me. She was patient, she did not judge, and she was everything I love her for. She waited for me to speak first, and then proceeded to very calmly and compassionately try and find out what was wrong. I explained to her, not mentioning specifics, what I had observed in the Emergency Department with the police officer. She immediately understood without much explanation why the events that transpired in The Wire affected me so much. I continued to cry and bawl my eyes out, until finally I regained my composure. I felt a lot better having shared my emotion with my wife, and for allowing myself to feel the raw emotion I was dealing with. This was an important moment for me because I realized that this needed to happen for me.

(To Be Continued)

Doctors Are Not Judges

I was browsing my Twitter feed this afternoon, looking over messages being posted from conferences occurring around the world I am interested in for the medical knowledge, advice for health care providers and trainees, and general uplifting ideas being shared. Suddenly, I saw a headline from The Atlantic on my feed I could not believe.

When Doctors Refuse to Treat LGBT Patients

Now, even without reading into the details of this news story, I can assure you that as a physician, there are very few situations when it is ethically or legally acceptable for a physician, nurse, nurse practitioner, physician assistant, or other health care provider to refuse to provide medical care to a patient.

As an Emergency Medicine resident myself, if a patient is threatening physical violence toward myself and my staff, if they are brandishing weapons, or endangering other patients, colleagues, or me, legal justification may support my decision to not treat them until the situation can be deescalated.

I have spent the past 13 years of my life training toward becoming a physician. At every step of the way, I learned that by becoming a physician, I make sacrifices. Many already are aware of the monetary and time sacrifices that many health care providers make in order to gain the expertise and training necessary to provide quality medical care.

Delivering medical care is a privilege, not a right.

Receiving medical care is a right, not a privilege.

According to The Atlantic article linked above, in Mississippi and Tennessee, laws have now been passed by legislature which makes it “legal for doctors, psychologists, and counselors to opt out of any procedure or choose not to take on any patient if doing so would compromise their conscience.”

There are numerous ethical dilemmas and consequences that arise from such laws.

First, physicians, who I can speak for as a physician myself, are trained and ethically taught to provide quality medical care regardless of our own beliefs, values, or ideals. For example, no one would allow physicians to decide not to provide care to a potential patient on grounds of race, gender, or age. Furthermore, as an Emergency Physician, I am bound by the Emergency Medical Treatment and Labor Act, a federal law which expressly prohibits a hospital, or the physicians providing care in them, to refuse medical treatment to anyone on the basis of financial ability to pay or not pay.

The laws in Mississippi and Tennessee are now permitting physicians, as well as psychologists and counselors, to refuse to provide medical care to individuals based on anything which goes against their conscience. That is in direct contradiction on moral and ethical grounds to what it means to be a physician.

Second, the problem with such laws is that they are extremely vaguely written. Picture the scenario below.

I am a physician in Mississippi. A patient presents to my facility who expresses to me views which I do not personally believe in. He tells me he thinks all Hindus should be sentenced to death. As a Hindu myself, this patient offends me, and goes against my own beliefs. Under the new law, I am now legally permitted to tell this patient I cannot provide them medical care. They will have to look elsewhere for treatment.

Imagine what you would feel like if your medical provider decided to refuse treatment to you based not on any scientific reason, but simply because they did not agree with your particular beliefs. Imagine how you would feel if you took your wife or your daughter to an OB/GYN because she was pregnant and needed prenatal care, only to find that your loved one cannot be treated because of their sexual orientation, their religious beliefs, or literally anything at all that might go against the physician’s “conscience.”

Furthermore, if Mississippi enforces these laws and allows physicians, psychologists, and counselors to decide when and why they may not want to deliver medical care, it will become increasingly difficult for citizens to receive medical care. It’s possible that if the patient holds a belief, religion, or other ideal that caregivers in the area do not agree with, they will certainly have decreased access to medical care.

This situation is in direct opposition to efforts such as the Affordable Care Act, which are attempting to make access to medical care easier. As a nation of Americans, we must take a step back from the situation and decide what kind of country we want to be. It has become popular, as Donald Trump has exemplified, to be bigoted, hateful, and discriminatory.

It has become acceptable, apparently, to pass laws to limit access to vital and crucial medical care like what happened with Planned Parenthood affecting millions of women this year. It has become acceptable, apparently, to pick and choose which Americans individuals, organizations, and now, medical providers can discriminate against. It has become acceptable, apparently, to base an entire political campaign on the grounds of discrimination, bigotry, and open hostility toward particular citizens of our nation.

America, we have to take a hard look at ourselves right now. This cannot wait. Who are we, as a society? The rest of the world is laughing at us. A nation founded on the noble concepts of the rights to life, liberty, and the pursuit of happiness is now segregating using conflicting value systems and discrimination. Our founding fathers established the United States of America not with the intention that one day, specific populations of people within our borders, who live alongside us, who deliver our medical care, who sell us our groceries, would be declared unworthy of the same rights and freedoms we all share. The men and women in our armed forces, and their families, do not sacrifice their lives for us to defend hatred, discrimination, or bigotry.

I implore you, if you believe in America, if you love your country and your countrymen and women, speak out against laws, organizations, and political parties which threaten the values that define who we are. I beg you, as a citizen of the United States born and raised within the confines of this nation, as a contributing member of society with love for all individuals around me regardless of what they believe in or look like, do not allow America to become a country defined by hatred or discrimination.

Save America. Save her, for your families, for your children, and for our future.

Language Choice in Health Care

Recently I read a fantastic blog post by @RenzaS, a writer with Diabetes who shares her perspectives on the patient experience and is a patient advocate. You should first read her post here on “Difficult Patients” to get background on this discussion.

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How we say things matters as much as what we say.

As a physician, an avid reader, and an unrefined, unexperienced writer, I understand the importance of our language and word choice. In my line of work, daily, I must pick my words carefully to help explain complex medical problems in a way my patients and their loved ones and caregivers can understand. I feel one of the services I provide my patients is actually translation – I translate the complex medical problems, treatments, and research I am tasked with understanding into terms my patients can understand.

That being said, I have to say that many health care professionals, in my experience, use language and terms that can be construed as offensive and derogatory. I bring up the issue because I want to encourage readers who are physicians, nurses, physician assistants, nurse practitioners, technicians, paramedics, etc, to consider changing the way they discuss patients and their care.

Below are some examples of terminology I have heard over the past 13 years which makes me uncomfortable. When I hear these terms, I cringe. I refuse to use them myself.

  • Patients in rooms or beds referred to by their room number, not their name, or even worse, by their disease or chief complaint.
    • Example 1: “Dr. Smith, the chest pain in 1…”
    • Example 2: “Dr. Lee, room 1 needs…”
  • Patients referred to by their disease process in a made up, often derogatory phrase.
  • Patients referred to as “difficult”

These are just some of the examples I have heard. Now keep in mind, I myself refuse to use these terms, or refer to patients in this way. The reasons why should be obvious. It is offensive and unprofessional! I know there may be those who disagree with me, and they might claim that how they discuss patients in private conversation is up to them. I have heard all to many times that in 2016, we worry too much about being “politically correct.” However, this is not about being politically correct.

This is about changing the current culture of health care which finds as many ways as possible to make the patient experience matter as little as possible, and which places the power in the physician-provider and patient relationship squarely in the hands of the physician-provider instead of in the hands of the patient, the most important person in health care!

So, the only term I have seen used that is quite frequently used is “difficult patient.” Healthcare providers often use the term “difficult” to refer to patients who are in distress of some kind which affects their decision making capacity. For example, a patient who is under the influence of mind altering substances like alcohol or PCP. Healthcare providers also use the phrase “difficult patient” to refer to patients who are angry, hostile, combative, or physically abusive. Especially in the Emergency Department, we often take care of patients who present via law enforcement or EMS because they are psychologically unstable, who may have diagnosed psychiatric illness, and are making it hard for us to care for them. Lastly, some healthcare providers use “difficult patient” to refer to patients who have many questions about their care or who question decisions made by the healthcare team.

All of these situations are different, but what I can honestly say in all of them, is that there is no need to use the term “difficult patient,” ever. It’s ambiguous and open to interpretation. I venture a guess that most patients actually take that phrase to refer to the last scenario above, referring to a patient who has many questions or concerns about their treatment. This term has a negative connotation and perpetuates a culture where the patient’s voice is less important or implied to be irrelevant, when in reality, the patient’s voice should be the loudest, and we healthcare providers should be working to augment their voices.

Renza recommended in her article here that we use the phrases “empowered” or “assertive.” I thoroughly agree with her, because these terms have positive connotations, and elevate the patient to the center of the healthcare provider-patient relationship. Renza also referred to @annareisman who wrote a wonderful article covering the inappropriate use of the term “difficult patient” and she emphasizes that patients who asks questions are excellent teachers. She stated, “Don’t dread patients bearing questions, I told my students. Welcome them. They’re some of the best teachers you’ll encounter.”

At the end of the day, patients are simply trying to receive care for their medical problems. As healthcare providers, it falls on our shoulders, based upon our years of training and commitments to our patients, to always do what is right for them. This doesn’t stop at our medical decision making. It absolutely includes our communication, because how you say things matters just as much as what you say!

 

An Ode to You, ED Nurse

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There are many people who work in health care. There are patient care technicians, physician assistants, custodial and housekeeping staff, dietary, patient transporters, nurse practitioners, and yes, doctors too. However there is truly, in my humble opinion, one individual in the hospital who does the majority of actual medical care. Yes, physicians, nurse practitioners, physician assistants, technicians, they all contribute important activities for patient care. Physicians, and their teams, intubate, place central lines, deal with complex medial situations and make decisions that change the course of their patients’ lives.

You may have guessed it by now. Yes, this is going to be about nurses.

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Nurses are the heroes of healthcare. No ifs, ands, or buts about it. Anyone who tells you otherwise is in denial. My purpose in sharing my opinions on nurses is simple: they are never, ever recognized enough for their tireless, selfless, genuinely caring efforts.

Don’t get me wrong! I am not saying that all those who work in healthcare don’t deserve accolades. They absolutely do! But truthfully, I have never been able to thank the nurses I work with for their hard work and efforts enough, and this is my attempt.

A wise nurse I worked with at the Baltimore VA ED taught me last July, when I was a brand new intern, that patients don’t go to hospitals to see doctors – they go to receive nursing care. It was profound, and true. Doctors get the glory for good outcomes, but though they are essential in the delivery of healthcare, most doctors are pretty useless without the nurses they work with to deliver actual medical care.

Look around the hospital. Who is giving patient’s their medication? Who cleans patients when they soil themselves? Who dresses a patient’s wounds? Who takes the patient’s vital signs? Who assesses patient’s more frequently than anyone else in the hospital – universally? Who deals with problems with patient care as they arise more often than anyone? If you answered anything else but nurses, you’re wrong.

All nurses, wherever they work, whatever their area of expertise, deserve recognition for their tremendous efforts. I thank the nurses I work with each and every day. I have learned from my mentors that whenever I leave a shift in the ED, before I leave for the day, to share gratitude with the nurses and other staff that helped deliver care that day (including housekeeping, administrative assistants, transporters, literally everyone!) It sounds silly, but don’t be mistaken, it’s so important to recognize those around you for their hard work.

That all being said, there is one kind of nurse that I have tremendous respect and admiration of. If I had to be stranded on an island and needed medical attention, I would want this type of nurse there to care for me – an ED nurse!

ED nurses work in a chaotic, stressful, and unpredictable environment, day in, and day out. They never know what they will deal with. They are often the first people in the hospital to see the sickest, most helpless patients – even before the ED physicians! ED nurses are tasked with the often challenging and sometimes impossible – take care of everyone, address all of their problems, with what resources you may have.

Do you have too many patients to take care of? Did your patient tech call out sick? Is the nursing staff short for the shift? Do you get to call for help, or ask administrators to reassign nurses from other departments? Nope. The answer is a resounding, “Deal with it, friend.”

The CDC states that in 2011, there were 136,000,000 ED visits in the United States. Each of these patients were cared for by at least one, often multiple ED nurses. That means more than 1/3 of the entire country’s population has essentially been cared for by an ED nurse. Not all ED visits result in admissions, so you must accept that ED nurses are the most seen nurses in the entire field. Let that sink in. (I may be wrong on that, and if I am, please let me know. I just don’t see it being any other way.)

I have witnessed, since I first set foot in a hospital as an Emergency Department volunteer clerk back in 2003, ED nurses exhibit such unwavering dedication and commitments to their work. They are cursed at, spit on, yelled at, and sometimes even physically attacked by their patients. They are responsible for taking care of multiple undifferentiated patients with often uncertain medical diagnoses all at once. Furthermore, if we as physicians have any issues with patients, their care, or anything related, we frequently rely on nurses to help guide us to the next resource we need.

The best physician advocates for a patient in the hospital are frequently ED physicians, because they see the patients earliest, and are tasked with deciding what the ultimate plan for a particular patient is. However, the ED nurses who work with those ED physicians are even stronger advocates for their patients, because they are the first to bring up issues with the physicians they work with. I’ve lost track of the instances when nurses were concerned about a patient’s condition, whether it was because they were complaining of worsening pain, their breathing was becoming too rapid, they had abnormal changes in their vital signs, or some other reason, and they brought up their concerns with the physicians they work with. Most of the time, in a good ED, the physicians will learn to respect the ED nurse’s assessment. Good ED physicians know they should trust and rely on the ED nurse colleagues for their clinical gestalt, or “gut feeling.”

Just to be clear, as well, ED nurses have an awe-inspiring ability for versatility and resilience. They often deal with the sickest patients before we know exactly what’s going on. They take care of patients that should be in an ICU, where the nurse to patient ratio is often 1 nurse for 3 patients or even 1 nurse for 2 patients, BUT, often carry 1 or 2 ICU level patients AND 2 or more patients. ED nurses are efficient, quick thinking, and a TON of fun to work with. They are smart, they are compassionate, and they are incredibly fun. I am so lucky that in the ED where I spend most of my time, not a shift goes by when I don’t laugh with the nurses I work with, and they have made me feel better about difficult patient encounters or helped me deal with suffering I have witnessed more than I can ever thank them for.

This is why, for the rest of my career, I will be sure to show my gratitude for and advocate for ED nurses everywhere.

I thank you, ED nurse, for the tremendous work you perform.

I thank you, ED nurse, for the role you play in public health and wellness through your role in the ED.

I thank you, ED nurse, for the sacrifices you make to take care of the entire country.

I thank you, ED nurse, for being the ultimate troubleshooter, the “MacGyver” of all nurses.

I thank you, ED nurse, for putting up with me, my colleagues, and aiding us in taking care of our patients.

I thank you, ED nurse, for somehow finding a way to get it all done, while maintaining a smile on your face, and keeping me laughing too.

I thank you, ED nurse, for coming back day, after day, after day, after day, to see so much hardship and suffering, often in a broken and dilapidated healthcare system that makes it harder and harder for you to do your work.

Never, ever change!

To everyone else, #thanknurses! I encourage you all to share gratitude with nurses you work with. Let’s use the hashtag #thanknurses to let them know we appreciate them. Spread the word, get your colleagues in on it, and share the love!

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Why Physicians Benefit from Social Media

As a teenager I grew up using social media platforms such as FaceBook. It was mostly used to keep in touch with friends and family and waste time. Those days of aimlessly browsing news feeds and playing FB games are gone. I also had a Twitter account I hardly used and mostly because I never knew how to actually use it. By the time I reached my second year of medical school, I had lost any interest in social media and my FB has been deactivated almost all the time for the past few years. My old Twitter account was deleted. I enjoyed focusing more on my day to day life and went about my routine.

Eeventually I reconnected with my now wife, graduated from medical school, and began residency. As a fourth year medical student, I learned about the phenomenon know in the social media world as Free Open Access Medical Education, abbreviated #FOAMed. See this fantastic post by Dr. Chris Nickson (@precordialthump) on the concept and how all kinds of medical personnel (nurses, technicians, paramedics, researchers, including doctors). I loved the entire thing!

What could be better for all stakeholders in healthcare than getting together on a shared platform, discussing new ideas about medical care, medical education and training, research, and all sorts of highly relevant and important issues affecting people that deliver emergency healthcare worldwide?

It got better and better as time went on. I became an avid consumer of #FOAMed. I connected with not only globally known clinicians famous for their ability to educate and spread wisdom in medicine, but have gotten to know literally thousands of people I have never met or even spoken to who I now regularly keep in touch with using social media.

As I enjoyed exploring Twitter as a doctor, it occurred to me that most physicians think one of two things when it comes to social media:

  1. I can use social media to make money by publicizing myself and driving potential customers to my website and ultimately medical practice.
  2. Social Media is a black hole where doctors go to get sued and lose their licenses and there is never a time for a physician to be involved on social media.

I lesrned to to shy away from those physicians who believed in number 1, and I was utterly shocked and confused by those in number 2.

However, as time went by, I identified that physicians are perpetually claiming they have no time for personal lives, with families, to keep up with their medical work, that for the vast majority of them, learning how to get active on social media in a climate which makes physicians in America worry that they will get sued for simply looking at their patients the wrong way is not ideal.

Physicians are value based individuals. They are trained to look at pros and cons, and weigh options, because they advise their  patients to navigate those situations on a daily basis as their career. This is my attempt to share the value.

I posit that many physicians deal with burnout and poor job satisfaction because they lack a support group of peers who they can discuss their concerns, experiences, and hardships with.

I hypothesize that physicians struggle to identify what information is relevant for them to know.

I believe that healthcare social media, or networks and communities of people that are passionate about not just delivering healthcare but shaping its future, is the BEST place for an engaged physician to be.

  1. My involvement on Twitter has allowed me to connect with other individuals excited and passionate about delivering quality patient care.
  2. My involvement on Twitter has opened my world to entire fields related to healthcare that I never even knew existed such as healthcare design and patient experience design.
  3. My involvement on Twitter provides me with an added layer of support beyond my family and friends who work in the same settings, devote their lives for better or worse to guiding patients & their families through suffering and pain on a daily basis.
  4. My involvement on Twitter especially chat groups such as Healthcare Social Media, Healthcare Social Media Philippines, Healthcare Social Media Canada, Bioethics Chat, Medical Education chat, and Patient Advocacy Chat.
  5. My involvement on Twitter has taken me not only to the most fun, knowledgeable, and influential people in Emergency Medicine, which is my field of medicine, but it has taken me to the patients and their advocates who are working tirelessly day in, day out, to make sure that patients are at the center of health care today and tomorrow. For examples, you must get to know @NatriceR, @CancerGeek, @Colin_Hung, and @Colleen_Young.

Why should physicians be active and involved in social media? 

In 2016, we have finally reached a point where physicians can engage in social media in a professional way, without compromising patient confidentially or laws such as HIPAA. Furthermore, the entire medical field is encumbered by physicians and other healthcare providers who are exhausted, stressed out, and struggling to deliver quality care while maintaining their own personal lives.

Examples I have myself experienced:

  1. I have  met wise educators in Emergency Medicine and have had new opportunities come to me just because I am enthusiastic, involved, and willing to try new things.
  2. I have connected with countless patients, patient advocates, healthcare designers, and read their blogs and ideas, and have become a more innovative, creative, and open minded member of the healthcare world now.
  3. I have found much needed support from colleagues and other individuals who deliver medical care when I have been dealing with depression and emotional anguish related to work.

I never once thought that when I started @S_P_MD, that I would be so positively impacted by it. Now I cannot imagine a life in which I do not use #FOAMed or Healthcare Social Media (#hcsm). The time has never been better for physicians to get active on #hcsm! Share this with a colleague who is skeptical and connect them with resources to help them get online!

10 Commandments for Intern Year

I’ve been inspired by the #TipsForNewDoctors trend on social media. I’ve decided to start posting some thoughts and advice based on what I have gone through on my blog.

These are simply recommendations I can make for any first year residents based on my own experiences and observations over the past 8 months of intern year. I don’t have any evidence to support my words, though I hope they might help others.

1) Thou shalt be a team player.

You should make it your priority to be courteous and respectful to everyone you encounter. This isn’t limited to your immediate resident colleagues, medical students, or attendings, but includes custodial staff, administrative assistants, patient care techs, transport staff, literally anyone. Make it a goal to get to know as many names as possible. Many of my heroes like Dr. Amal Mattu and Dr. Michael Winters have emphasized that learning names positions you to be a leader.

2) Thou shalt take care of thyself.

If you are chronically sleep deprived, sick, or emotionally unstable, you not only put yourself at risk of burnout and further health problems, but you put the lives of your patients in danger. Imagine when you are on call in the ICU, in many hospitals making critical decisions for your patients without direct oversight at times. Seek help early if you start to find you are struggling. Every residency program must guarantee resources for physical and mental wellness.

3) Thou shalt read daily.

This is a tough one for me to do myself, but I guarantee you that if you can keep this one up, you will excel. Success as a resident, attending, and beyond does not require marathon study sessions in the library. Leave that in medical school where it belongs. Read about 1 patient you care for daily. It can be FOAMed, a review paper, or even discussion with a colleague. Something. Every day!

4) Thou shalt not incur debts.

While it may seem pointless to be fiscally responsible if you have hundreds of thousands of dollars in debt like me, do not be fooled. You will have limited month to month cashflow, and any extra debts you incur, especially for purchases you don’t need, will cause you unneeded stress when bills are due. Every penny you don’t spend is going to make a difference as a resident. Be wise with your money and you will be glad in the end.

5) Thou shalt put the patient first.

It may seem silly to emphasize this point, but entitlement and privilege are pervasive among medical students and physicians. Because of the hard work and sacrifices we all endure, the bumps along the way can be tough to deal with. Avoid giving into the urge to make everything about you. The day you became a medical student, and especially the day you start residency, you are truly making the rest of your life about your patient. You had many years to make up your mind about being here, but your patient, especially when they are sick, did not ask to be in the hospital. Maintain compassion for your patients and their families. We sometimes take health and healthcare for granted because we see it from the physician perspective. Try to see the situation through your patient’s eyes and you will understand it can be frightening and overwhelming to navigate the system.

6) Thou shalt not sign out loose ends.

Trust me, if you don’t know what I’m talking about, you will know soon enough. Do not be that resident in your program who develops a reputation for awful sign outs. Sometimes you have to stay late past your shift or call night to close the loop. Resist the tendency to think of it as doing procedures or examinations you don’t want to do; instead think of it as better for patient care. Nothing is worse for your patients than poor quality sign outs. If you need to call a consultant, perform a procedure, complete an examination, or finish a discharge or admission, be the resident that stays to take care of it. It’s not just a good habit to develop. It’s better for patient care, and that’s ultimately your first priority.

7) Thou shalt be professional with everyone.

This is a huge one. There are going to be times when you have a sick patient and you might feel like staff around you are not helping you with their care. There will be moments when you need help from a consultant or colleague in a different specialty or field and that physician may disagree with your plan or concerns. There are frequently situations when you will feel unsupported and like you are the only person who wants to care for your patient. You are not alone, and it is never, ever acceptable to be rude, discourteous, or nasty to others. It is never okay to raise your voice, swear, speak profanity, or speak rudely to another person. It doesn’t matter who that person is, whether a colleague, staff member, patient, or other human being. You are now held to a higher standard, and you must accept that, or you will flounder.

8) Thou shalt be early.

I must admit, this one is challenging for me even to this day, because I have trouble being organized. I am working on it though. That being said, it doesn’t matter what kind of residency you are starting, being early is the new “on time.” Showing up on time demonstrates work ethic and everyone remembers if you are late. If you develop a reputation for being late, it can be hard to overcome this moving forward. It sends the wrong signal, which is that you don’t care about your work. You most definitely do care about your work, and you have worked hard to get to this point. Don’t screw it up by being late.

9) Thou shalt surround thyself with positive influences.

Wise people rarely become wise by their own virtue. They simply understand that they are influences by those around them. If you seek out uplifting, motivated, and success oriented individuals to spend time with, get advice from, and learn with, you will 100% benefit from this. As you move forward, understand that not all health care providers are created equally. Some of them ended up where they are by mistake, are unhappy, and will try to get you to join their complaint corner. I say, find a senior resident or attending you admire early on, and reflect on what makes them so good at what they do. What qualities do you appreciate about them? What about their personality or professional life do you wish to emulate? Then, go one step further and identify where they may be able to improve. Write all of this down, and you have your road map for your own growth and development.

10) Thou shalt remember you are human.

At the end of each day, you need to take a deep breath. Being a physician, nurse, physician assistant, nurse practitioner, patient care technician, EMT, paramedic, or any other staff member that cares for patients, will be hard on your mind, body, and soul. You are not perfect. You have limitations. You should aspire to be your best but accept that you will have some bad days. Perhaps many bad days. Learn to laugh at yourself. Develop a tough skin to receive criticism and use it as an opportunity to improve. When you see patients and their families suffer, allow yourself to feel their pain and empathize with them. Humanism is sorely lacking in healthcare today. Patients, doctors, and everyone around can tell. Bring humanism back to medicine.

If you have any feedback, suggestions, comments, criticisms, or advice, or if you want to add your own commandments to this list, please comment or reach me at sspatel@umem.org or @S_P_MD!