Wednesday, October 17, 2012

Depressed Doctors: When everyone expects you to "heal thyself."


What percentage of doctors suffer from depression?

The same percentage as anybody in any other profession.  Doctors are JUST AS likely to suffer from depression as the population at large.  They're also just as likely to have a seizure disorder, MS, diabetes or anything else.

Being a doctor doesn't mean you're immune.  But when it comes to depression, being a doctor does make a difference.

Compared with the general population - how often do doctors commit suicide?

TWICE AS OFTEN! 
Male physicians are 1.4 times more likely, and female physicians are 2.27 times more likely.

Why?

2 main reasons:

1.  Doctors know how to die - they see it every day.  They know what pills will kill them.  They can write the prescription, fill them, and take all they need to go quietly into the night.

2.  They don't get treatment.  The stigma for mental illness may have gone down for patients - but not for doctors.  Doctors still expect each other to "get over it."  When medical students were anonymously polled - 14% met the diagnosis for depression.  (about average for any population)
 - Here's why they didn't want to seek treatment or tell anyone:

 - 53% thought telling a counselor would be "risky"
 - 62% thought they'd be seen as "less intelligent"
 - 83% thought they'd be seen as "unable to handle responsibilities"
 - 56% thought their opinion would be less respected

Of practicing doctors that were polled:

 - 14% prescribed their own antidepressants (VERY DANGEROUS AND ILLEGAL)
 - 10% feared losing their practice privileges
 - 8% feared losing their medical license

Doctor's know intellectually that depression is an illness just like every other.  But we all went through med school, we know what's expected, and we know that doctors aren't supposed to get depressed.  We are taught that depression is weakness.  If you do feel depressed you should just buckle down and work harder and push on through.  Seeing a counselor or therapist is weak.  Take a pill if you have to - but deal with it on your own.  If you play the depression card - you'll be on the outside looking in.

It was a humbling lecture to hear today.  I sat in a room with 200 of my colleagues, and we talked about how much we care for our depressed patients, yet we continue to hold each other to a "higher" (impossible) standard.  Of all professions - Doctors should be the most understanding.

It was sad to read the studies, and see the results.
The medical community isn't just as bad as everybody else - we're worse.

Monday, October 15, 2012

Studying For Tests: My Two Decades of Evolving Study Techniques

Last week I took the PRITE exam.  (Psychiatry Resident In Training Exam)

I still have more tests to take in the future: Child Psychiatry Board Exam, General Psychiatry Board Exam, etc...
I may be a doctor, but I only got here by becoming an expert test taker first.  Which means I had to learn how to study.
I am not the smartest or best test taker by far.  I did not glide through medical school, and I was not in the top of my class.  I worked hard, constantly evolving my study skills to meet the latest challenge.  Here is my journey.


ELEMENTARY SCHOOL

 - I almost never studied.  It was so bad that when there were spelling tests and two words were pronounced the same (red, read) I'd have to ask the teacher to use the word in a sentence because I had never looked at the list.
I only studied when there was a competition.  When I was in a Geography competition I spent hours and hours at home memorizing all the countries.

HIGH SCHOOL
 - I studied a little for classes, but I knew there was one test that mattered most: The ACT.  I checked all the colleges I wanted to go to - and figured out what ACT and GPA I would need for a scholarship.  My GPA would take consistent work - but the ACT was a single test with HUGE results.  That's why I needed to figure out how to take it.  I took it my freshman year - I didn't get the score I wanted.
I took a review course and took it my sophomore year - still too low.  I took it again my Junior year - too low.  I took another review course and then took it again my junior year - 1 point too low.
I took it for the fifth time my Senior Year - NAILED IT!

I earned the scholarship I needed to be able to pay for college, and off I went.

COLLEGE
 - This is where I learned the necessity of study groups.  I walked into a physics class and quickly discovered - I didn't get it.  I could go to lecture and read the book and it still made no sense.  So about the 2nd week of class I paid attention to who was bored, but always knew the answer.  Two guys in the front (Jake and Pete) were always joking together, but when the teacher called on them - they answered everything right.
I walked up to them after class and asked if I could study with them. 
They already had a study room reserved 3 days a week at the same time for the whole semester.
All 3 of us aced Physics.
I then took Calculus.  I couldn't find a good study group so I went to the math tutoring center.  I sat there every afternoon for 4 months.  I used the same tutor every time.  He got paid by the school, I learned calculus, and thanks to him I aced that course.
Then came Genetics, Anatomy, Physiology, Organic Chemistry, Evolution, Pathophysiology, etc...
That's when I found my perfect study partner - Kyle.
He was more "bookish" than I was.  I knew the lectures.  I knew what the teachers liked, what topics they cared about and what lecture facts they were most likely to test.
Kyle new the book.  He knew the concepts, the underlying theory.  We sat in study rooms and wrote on white board for hours and hours - recreating metabolic pathways and memorizing names, equations, and formulas.  If not for him, I never would have passed those classes.
For a "pre-med" there is one test that determines the rest of your life: The MCAT.
It is the test to get into medical school.  I couldn't just take it 5 times to get the score I needed, because med school's don't just get your top score, they get all your scores.  They want someone who took it once and nailed it.
So - I decided to study for 1 year with a group of eight guys.
We took the formal practice exam nine months before the real thing.  We all scored too low.  We then met EVERY Saturday and practiced.  We reviewed practice questions, took practice tests, quizzed each other, wrote practice essays.  We worked, and worked, and worked.  One year later - I had my high score, and I was accepted at multiple medical schools.

MEDICAL SCHOOL
 - This is where I learned the art of note taking and an exact / never changing schedule.  By this time I was married with a child and I would have two more children before the end of medical school.  I needed family time, and I needed it to be dependable and predictable.
So I car-pooled with three classmates.  We left at 6:30 a.m. and came home at 5:30 p.m.  Whether we had classes or not - we were at school for 11 hours a day.  Saturday mornings I spent at the library from 9-12... always.
I learned that there was WAY too much material to review.  I needed one place to put all the pertinent information.  ONE page of notes for each test.
My first year the page looked like this:

By second year it looked like this:

I had to have a faster way to review, and to know what was important for the test.
We had study groups every day.  We always got together the night before a test to review again.  We always invited our friend Joel (the smartest guy in the class who lived near us) to join us.  He would give us the info we never thought to learn.  He would know the answers to questions no one had asked, and no one cared about...except the professor.  I learned enough to pass from my study group, I learned enough to do WELL from Joel.
When the 11 hours got too boring - I found a way to make studying more fun.  When studying anatomy I purchased flash cards with every muscle, bone, artery, vein, and organ labeled.  I'd place the cards all around the edge of  a pool table - and start a game.  Every shot I took - I'd memorize everything on the card under the cue before I took the next shot.  My games of pool took a long time - but I aced my anatomy tests.
I also learned to relax and recoup.  After EVERY test, we'd play basketball.  About 15 guys showed up every time, and we'd play for an hour or two. (you have to do something to stay sane.)

In medical school, there is a test that MUST be passed to go to residency -  the General Medical Boards.(USMLE or COMLEX)  It's actually three tests, each about one year apart, hundreds of questions, hundreds of dollars to take each.
I studied for each one for six months.  I bought the books, I listened to the review lectures, I took the practice tests.  I spent thousands of dollars on review materials, travel, hotels, and the tests themselves.  I didn't get the highest scores, but I passed every single test the first time. 

RESIDENCY
 - It finally happened.  I got to the point where I can read a book and understand the material and remember it.  I now have 4 kids and a very busy position in my church.  I really don't have time to get together for study groups.  So I read.  I have a book with me EVERYWHERE.  I have one at work to read between appointments.  I take one to the DMV while I wait in line, read it on my lunch breaks, and keep one on my night stand to read before going to bed.
That way I can always play with my kids, and when they move on to something else - I can read. 

Why do I mention all of this?  Today I spoke with a sophomore in college whose grades are slipping.  He told me "I've never had to study and I just don't really know how."

This is what I told him.  You start by looking for new solutions.  You go to the tutoring center, you ask people if you can study with them, you make routines and schedules, you find a way.

I didn't make it through school unscathed.  I never had a 4.0 in high school or college.  I almost failed a course in med-school (the week after my 2nd baby was born).  I am not the smartest, or the brightest.  I'm smart "enough," and I learned how to study.  That is the "secret" of my success.

Wednesday, October 10, 2012

Book Review: Long-Term Psychodynamic Psychotherapy

First – I’m really curious to see if ANYONE reads this review.  I mean really – with a title like that – how many people are really going to find this on a google search?  This isn’t exactly a popular topic. Hunger Games and Honey Boo Boo it ain’t.

But – I read it – it helped me, and here’s what I thought.
The author did a good job writing about a topic that few would read past the first page. 
The first topic?  MISCONCEPTIONS.

They explain that it isn’t about the stone faced therapist, sitting mostly in silence and only speaking to say “mmm-hmm” or to ask about the patient’s sexuality.
It’s about the relationship between the therapist and the patient.  They’re both real people – both have backgrounds and upbringings and biases and conversation styles and patterns and soft spots and rough edges etc…

The author explained Klein, Freud, Kohut, Bolwby, Stern and others.  But none of them are God; none should be followed precisely.  They are people who had theories, and their theories taught us something.
This book helped me the most by teaching me what NOT to do.  Don’t over analyze, don’t interpret too quickly.  If the patient says I remind them of their father, just leave it alone.  If they mention a past experience, just listen.  Once they mention the same subject 3 or 4 times, once a pattern is readily apparent - then bring it up.  Don't assume to know what it means - just bring it up.  Sure I'll have idea and theories, but not push them on the patient or they'll pull back.

If they mention a dream - don't try to interpret it.  If they give an interpretation - fine.  If it reminds me of a recurring thing they've brought up many times - ask if there might be a connection.

I learned to slow down and avoid jumping to conclusions.

This book teaches how to do psychotherapy, how to deal with resistance, when to interpret and when to just listen.  It taught the good and the bad of transference and countertransference - when to bring it up and when to just acknowledge it and move on.

It explained the goals, the purpose, the meaning behind it all.  It gave me another useful tool to use with patients.  I think that's the point, if you learn lots of medications, lots of therapies, and lots of ways to help - you'll have a better chance of picking the right one.  "If all you have is a hammer, everything becomes a nail."

Here are a few of my favorite quotes:

"When in doubt, be human." - p. 57

"The young therapist - fearing spontaneity, human engagement, and a naturalness of response - is overly rigid and formal." - p. 71

"Therapists are privately passing judgments on the patient all the time." - p. 72

"We might regard resistance as a way that patients show us who they are...resistance is not 'bad' behavior on the part of the patient." - p. 117

"Patients are boring for different reasons...the art of therapy includes making the boring patient a fascinating subject of study." - p. 161

Monday, October 1, 2012

Blog Post #100

I created this blog in April 2010.  It began as a book blog to post my book reviews as I read throughout the year.  I broke form on Independence day when I posted the Declaration of Independence.  Then a few months later I posted my first off-topic post - about Conservatives not being close-minded.
I posted a total of 13 times that first year.

In 2011 I didn't do much.  I posted 11 times, mostly about books again and also one really LONG post comparing two of my favorite father figures - Tevye and Jean Valjean.
Then in February of this year I decided I wanted to get more serious about writing.  I also decided that I wanted a forum to share my thoughts.  I've now written 76 posts this year.
I knew that to have a popular or successful blog I would need a specific topic - some niche or genre to draw people to my blog.

I failed.

I didn't want to be limited to discussing politics, or religion, or psychiatry, or medical research, or books.  I wanted to discuss EVERYTHING!  I wanted a venue where I could write anything too long to put on Facebook.
(maybe that's why my blog only has 4 followers after 100 posts?)

I don't know everything, and I am not THE EXPERT on the topics I blog about.
 - I really am a Simple Citizen who is just trying to make a difference in this world.  Someday I hope to write something important enough that it gets referenced from some big news source and thousands of people end up reading my writings.  I'll never monetize my blog - because that's not the point.  I'm not here to make money, I'm here to make a difference.

For now I'll practice on all of you.  Most of you are Facebook Friends who follow one of my links here.  The rest of you - I have no idea how you landed here.  But if you have feedback, critiques, encouragement, corrections, or even topics you'd like me to research and write about (because I'm nerdy like that) - just ask.

Also - on the off chance someone else wants to try writing a blog post - I'd be happy to have my first "Guest Blogger."  I guess we'll see. 

Thanks for reading.  It's nice to know at least a few people are reading what I write.