Culture in the time of corona II
4 years ago
Sunday, February 21, 2010
Thursday, February 11, 2010
Medical Medical Student Burnout and the Challenge to Patient Care
by Pauline W Chen, MD, writer and consultant surgeon
This will be worthy to those studying medicine in Pm4
Not long ago, I read a paper titled “Burnout and Suicidal Ideation Among U.S. Medical Students” in The Annals of Internal Medicine. It brought back a flood of memories.
Skip to next paragraph
Well
Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.
Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.
Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?
Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.
Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.
With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.
It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.
In 2006, Dr. Liselotte N. Dyrbye and her colleagues at the Mayo Clinic found that nearly half of the 545 medical students they surveyed suffered from burnout, which they defined as professional distress in three domains: emotional exhaustion, depersonalization and low sense of personal accomplishment. Moreover, the researchers found that each successive year of schooling increased the chances students would experience burnout, despite the fact that they had entered medical school with mental health profiles similar to those of their peers who chose other career paths.
More recently, in the paper on burnout that had first caught my eye, Dr. Dyrbye and her colleagues widened the scope of their research, analyzing survey responses from 2,248 medical students at seven medical schools across the country. Again, nearly half of the students surveyed met the criteria for burnout. But the investigators discovered an even more ominous finding: 11 percent of all the students surveyed also reported having suicidal thoughts in the past year.
Dr. Dyrbye notes that we are just starting to learn about the high levels of distress in medical students. “It’s incredibly disconcerting,” she said. “What are the causes? And what can we do as educators to facilitate their well-being? We need a better understanding of the causes of stress to design interventions that will help improve student wellness. Students, just like doctors, need to take care of themselves in order to take care of their patients.”
Medical schools have more recently recognized the importance of this issue. For example, the Liaison Committee on Medical Education, the accrediting authority for medical schools in the United States, now mandates that all schools have a program for student wellness in place that includes “an effective system of personal counseling for its students.”
But beyond the personal implications, what are the ramifications of medical student burnout for patients?
In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.
“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”
By the time my dinner with my former classmates last week had ended, we had made plans to stay in touch and to do something I had never been sure I would ever do: return to my medical school in two years’ time to celebrate our 20th reunion. Over the course of our dinner conversation I felt strangely connected and nostalgic about medical school; I was deeply moved by what my two classmates had chosen to do with their education. One is a well-loved community obstetrician/gynecologist; the other is a psychiatrist devoted to teaching, working in a county medical clinic and caring for severely traumatized Hmong refugees. And both love their work as doctors.
As I listened to them talk about their work, I was reminded of one other thing Dr. Dyrbye had told me. “We need to change things,” she had said, “because maybe the students who are most vulnerable are the ones who are most empathic.”
This will be worthy to those studying medicine in Pm4
Not long ago, I read a paper titled “Burnout and Suicidal Ideation Among U.S. Medical Students” in The Annals of Internal Medicine. It brought back a flood of memories.
Skip to next paragraph
Well
Medical school was not easy for me. I knew that I wanted to become a doctor to help people, but I had given little thought to the process. I was poorly prepared for many things: the pressure to excel in ways that seemed so far from caring for people; rapidly mounting debts I signed off on every semester; a roller coaster existence from chronic lack of sleep; hazing from the more experienced students and residents; and the realities of patient suffering despite my best efforts.
Even surgical residency, despite the relentlessly long hours, seemed so much closer to what I wanted to do.
Some of my professors tried to “humanize” the process. They invited us to dinner in their homes, supported our extracurricular efforts to set up health screening clinics in low-income neighborhoods, and tried to make our basic science courses more relevant to working with patients. But sitting where I am now, as someone who teaches medical students and who loves helping others as a doctor, I can understand the challenge they faced. Given the fire hose of information medical students must learn in just four years, how does one ever gently take a sip?
Despite my teachers’ efforts, I was about as miserable in medical school as I had ever been. I felt alone. Neither I nor my classmates could admit to failure, and the last thing I wanted to do was to let anyone but my closest friends know just how unhappy I was. Success in medical school was the first step to a future of helping others, and I was not about to jeopardize that.
Last week I had dinner with two former classmates from that time. We had not seen each other in over a decade, and after catching up on personal news and reminiscing about gross anatomy lab and our first nights on call, one of them said quietly, “I hated med school. I wanted to quit.” The elephant in our collective memories had broken free.
With that elephant now running loose, and the three of us more comfortable with our own professional accomplishments, the conversation grew more honest. “If you look over my entire lifetime,” my other friend said, “those four years were the lowest point in terms of self esteem.” He held his hand out in the air, plotting an imaginary line that dropped precipitously to his knees.
It took nearly 20 years for the three of us to learn that we had each been miserable as medical students. It has taken even longer for researchers to discover the extent to which such feelings exist among American medical students.
In 2006, Dr. Liselotte N. Dyrbye and her colleagues at the Mayo Clinic found that nearly half of the 545 medical students they surveyed suffered from burnout, which they defined as professional distress in three domains: emotional exhaustion, depersonalization and low sense of personal accomplishment. Moreover, the researchers found that each successive year of schooling increased the chances students would experience burnout, despite the fact that they had entered medical school with mental health profiles similar to those of their peers who chose other career paths.
More recently, in the paper on burnout that had first caught my eye, Dr. Dyrbye and her colleagues widened the scope of their research, analyzing survey responses from 2,248 medical students at seven medical schools across the country. Again, nearly half of the students surveyed met the criteria for burnout. But the investigators discovered an even more ominous finding: 11 percent of all the students surveyed also reported having suicidal thoughts in the past year.
Dr. Dyrbye notes that we are just starting to learn about the high levels of distress in medical students. “It’s incredibly disconcerting,” she said. “What are the causes? And what can we do as educators to facilitate their well-being? We need a better understanding of the causes of stress to design interventions that will help improve student wellness. Students, just like doctors, need to take care of themselves in order to take care of their patients.”
Medical schools have more recently recognized the importance of this issue. For example, the Liaison Committee on Medical Education, the accrediting authority for medical schools in the United States, now mandates that all schools have a program for student wellness in place that includes “an effective system of personal counseling for its students.”
But beyond the personal implications, what are the ramifications of medical student burnout for patients?
In a third study, Dr. Dyrbye found that when tested for empathy, medical students at baseline generally scored higher than their nonmedical peers. But, as medical students experienced more burnout, there was a corresponding drop in the level of empathy toward patients.
“What do they really need to know before graduating from medical school, and how could they most efficiently learn?” Dr. Drybye asked, reflecting on one of the central challenges of medical education. “All the information we want to share with them is not necessarily what they really need to learn.”
By the time my dinner with my former classmates last week had ended, we had made plans to stay in touch and to do something I had never been sure I would ever do: return to my medical school in two years’ time to celebrate our 20th reunion. Over the course of our dinner conversation I felt strangely connected and nostalgic about medical school; I was deeply moved by what my two classmates had chosen to do with their education. One is a well-loved community obstetrician/gynecologist; the other is a psychiatrist devoted to teaching, working in a county medical clinic and caring for severely traumatized Hmong refugees. And both love their work as doctors.
As I listened to them talk about their work, I was reminded of one other thing Dr. Dyrbye had told me. “We need to change things,” she had said, “because maybe the students who are most vulnerable are the ones who are most empathic.”
Sunday, January 3, 2010
HAPPY NEW YEAR!!
Ah, Nyoke Lee's Family!
Wherefore art thou abandoned?
What has become of your family?
All busy with their new lives, as it seems.
We have the largest group in IMU - Chia Yew, Michelle, Shin Yee, Hui Chuin, Marcel, with Ko, Tim and Beng Ying due to join them in two months
The next largest group in the UK. Sorta.
London - myself, Kim and Li Wei
Edinburgh - Su-Ern and Ken Vin
Nottingham - Roshan
Cardiff - Jason
Sheffield - Chiun Min
Then there are those scattered elsewhere
Sharon in Harvard
Kai Lun in Russia
Aly in HELP
Joanne in PMC
Daniel, Aussie-bound
Leelian the activist
Shin Yi still MIA
Not forgetting the devolved ones,
Jamie in U Penn
Geetha in Indonesia
Poh Hui about to leave to Aussie soon-ish
May Suen and Esther still in INTEC
Sue Wei in Cardiff
Hwang Yang just finished his A-Levels
And the pseudos!
John in Nilai
Hui Ning in St Andrews
William to start in IMU
Oh yes, all leading very busy lives as we each embark on our own journeys of life.
Still, we have the Book of Travelling Secrets, keeping us all together.
It is now due to pass from the hands of Charles to that of Ah Lek Ken Vin.
And I am certain that despite the apparent lack of activity on the blog's part, or the Facebook group, PM4 is never far from our minds.
I know it isn't for me.
What lies ahead for the Family?
Only time will tell.
Friday, December 11, 2009
Sunday, October 25, 2009
Drawing the Line
I have forgotten birthdays, forgone gatherings, denied the existence of group lunches, made up false excuses and turn the opposite direction - all in the name of objectivity and time efficiency. I didn’t use to be so. I used to be able to while away hours, talking about nothing, with no tangible result at the end of it, except maybe a warmed chair. Now that chair is unoccupied, but I have papers and certificates of better academic performance. Also now, if I were to sit in that chair, I) not many will occupy that chair next to me ii) I would fidget in that seat thinking that I’ve got more important things to do.
Should this be so? There seems to exist this very delicate balance between friends and work. In my quest to improve my studies and my knowledge on American politics or ‘serious’ issues such as laws, I have neglected friends and even family. Even though my absence is felt and sometimes even hurt, I do nothing to stop that. I can defend it by saying I’m striving for a greater good. That though this may suck temporarily, I’ll make up for it with better grades and with more information in my head how to talk ‘informedly, and without bias’. On the other hand, I do not want to defend myself. There is no way I can justify not spending more time with my parents and siblings when this could be my last year with them before going overseas. Nor can I justify my paper accomplishment and my ambition to be successful in an occupation to be more important than making the woman that raised me for 18 years, regardless of hardships, happy by just agreeing with all the disagreeable things she might say. Or that friend who sacrificed her own time for me, but I would not accord the same to her.
Where is the middle line drawn between these two extremes?
Where does focusing on goals stop?
How does it fit into making others (but not necessarily, yourself) happy?
When does social obligation compensate for being selfish?
It’s easier to say balance than to actually stand on that trapeze’s rope itself.
Note : Class Dictator takes this opportunity to apologize for any hurt feelings caused by her. She is currently on a caffeine high and yes, she realizes this is her first post here *slaps hand*. I hope you don’t mind sombre, reflective and somewhat philosophical :)
Should this be so? There seems to exist this very delicate balance between friends and work. In my quest to improve my studies and my knowledge on American politics or ‘serious’ issues such as laws, I have neglected friends and even family. Even though my absence is felt and sometimes even hurt, I do nothing to stop that. I can defend it by saying I’m striving for a greater good. That though this may suck temporarily, I’ll make up for it with better grades and with more information in my head how to talk ‘informedly, and without bias’. On the other hand, I do not want to defend myself. There is no way I can justify not spending more time with my parents and siblings when this could be my last year with them before going overseas. Nor can I justify my paper accomplishment and my ambition to be successful in an occupation to be more important than making the woman that raised me for 18 years, regardless of hardships, happy by just agreeing with all the disagreeable things she might say. Or that friend who sacrificed her own time for me, but I would not accord the same to her.
Where is the middle line drawn between these two extremes?
Where does focusing on goals stop?
How does it fit into making others (but not necessarily, yourself) happy?
When does social obligation compensate for being selfish?
It’s easier to say balance than to actually stand on that trapeze’s rope itself.
Note : Class Dictator takes this opportunity to apologize for any hurt feelings caused by her. She is currently on a caffeine high and yes, she realizes this is her first post here *slaps hand*. I hope you don’t mind sombre, reflective and somewhat philosophical :)
Saturday, October 10, 2009
Inner Medial Femoral Trauma: Etiology and Treatment (CY Kong, 2009)
Inner Medial Femoral Trauma or Inner Thigh Trauma (ChiaYewnian Syndrome) was first described by Kong CY in 2009 in an isolated case involving a patient named Chi Ko Pek*, a 19 year old male . Chi Ko Pek presented with numbness of the inner thigh and distinct post traumatic stress disorder. After further inspection of the site of trauma and interview, it was found that Chi had presented with a disease that was never reported before in Medicine.
Etiology:
This trauma is humanovector borne. A humanovector in this case Ah Piang the Garang*, an 18 year old female, had inflicted trauma by touching the inner thighs of Ko with her phalanges. This disease will only manifest with cranial (upward) progression of phalangeal stimulus onto the medial inner thigh. Trauma is remarkably more marked if phalangeal stimulation proceeds to the pubic area. Humanovectors of Chiayewnian Syndrome have exhibited abnormally high amounts of oestradiol in females and testosterone in males and very pronounced levels of pheromone secretion. They however curiously are rarely sexually active. This an be explained by the fact that their celibacy actually drives them to out put any suppressed sexual needs to committing Inner Thigh Trauma. Inner Thigh Trauma has a higher incidence in females than males. Patients almost always are atrichomic (hairless) in the lower limb.
Diagnosis:
The signs and symptoms include the universal sign of embarassment- the obsessive adduction of the lower limbs. The adductor magnus muscles of the legs are in a contracted and stimulated state for a prolonged period of time. This can be considered biopsychosocial manifestation of the trauma to prevent further stimulation of the site and to protect from any more trauma. There is marked pathology of mindset in the patient, with vasodilatation especially in the facial area, indicating a sympathetic response (from stimulation by cervical outflow). There is marked numbness indicating sensory fatigue of touch receptors in the medial inner thigh. There is marked psychological trauma: post traumatic stress disorder has been reported in many such patients with Inner Thigh Trauma.
Treatment and Prevention:
The Adductor Magnus muscles
The best method of preventing such incidents are strengthening of the adductor magnus muscles of guys. Posture when sitting is also important. Sitting with legs closed (aductor magnus muscles contrated have shown to significantly reduce levels of Chiayewnian Syndrome.
When patients have exhibited symptoms, there is nothing much health care givers can do. It is as much a psychological disorder as it is a somatic pathology. The first thing to assess is as to the extent of the trauma. It is classified below
1 cm- 0 cm from pubic region: Highly SEVERE (needs immediate psychological intervention)
5 cm- 1cm from pubic region: SEVERE ( counselling)
More than 5 cm from pubic region : No intervention needed, surveillance recommended
Numbness in the leg usually subsides within a day while massage with deep heat on the adductor magnus muscles relieves it from contraction and promotes relaxation.
Stress medication should be prescribed if needed.
Etiology:
This trauma is humanovector borne. A humanovector in this case Ah Piang the Garang*, an 18 year old female, had inflicted trauma by touching the inner thighs of Ko with her phalanges. This disease will only manifest with cranial (upward) progression of phalangeal stimulus onto the medial inner thigh. Trauma is remarkably more marked if phalangeal stimulation proceeds to the pubic area. Humanovectors of Chiayewnian Syndrome have exhibited abnormally high amounts of oestradiol in females and testosterone in males and very pronounced levels of pheromone secretion. They however curiously are rarely sexually active. This an be explained by the fact that their celibacy actually drives them to out put any suppressed sexual needs to committing Inner Thigh Trauma. Inner Thigh Trauma has a higher incidence in females than males. Patients almost always are atrichomic (hairless) in the lower limb.
Diagnosis:
The signs and symptoms include the universal sign of embarassment- the obsessive adduction of the lower limbs. The adductor magnus muscles of the legs are in a contracted and stimulated state for a prolonged period of time. This can be considered biopsychosocial manifestation of the trauma to prevent further stimulation of the site and to protect from any more trauma. There is marked pathology of mindset in the patient, with vasodilatation especially in the facial area, indicating a sympathetic response (from stimulation by cervical outflow). There is marked numbness indicating sensory fatigue of touch receptors in the medial inner thigh. There is marked psychological trauma: post traumatic stress disorder has been reported in many such patients with Inner Thigh Trauma.
Treatment and Prevention:
The Adductor Magnus muscles
The best method of preventing such incidents are strengthening of the adductor magnus muscles of guys. Posture when sitting is also important. Sitting with legs closed (aductor magnus muscles contrated have shown to significantly reduce levels of Chiayewnian Syndrome.
When patients have exhibited symptoms, there is nothing much health care givers can do. It is as much a psychological disorder as it is a somatic pathology. The first thing to assess is as to the extent of the trauma. It is classified below
1 cm- 0 cm from pubic region: Highly SEVERE (needs immediate psychological intervention)
5 cm- 1cm from pubic region: SEVERE ( counselling)
More than 5 cm from pubic region : No intervention needed, surveillance recommended
Numbness in the leg usually subsides within a day while massage with deep heat on the adductor magnus muscles relieves it from contraction and promotes relaxation.
Stress medication should be prescribed if needed.
Published in the Peeamfourianic Journal of Medicine October 2009.
*All names have been changed in accordance with medical ethics.
Sunday, October 4, 2009
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