Medical students' challenges in the 21ST Century

A significant article about medical students' challenges and survival tactics:
http://www.kevinmd.com/blog/2013/07/medical-students-survive-21st-century-medical-school.html.

There are fundamental changes since my generation (and several others, more recent) went to med school. I don't know whether I ought to feel relieved or disappointed. Maybe some of both.

Radical Thinking by MDs and others

Have spent many hours finding email addresses of physicians, RNs and others in the listing of "Ideal" (patient centered) practices I can appreciate the enthusiasm of these practitioners.
This post by a physician mirrors the thinking in the site I had found: http://thehealthcareblog.com/blog/2013/07/21/the-office-visit-revisited/?utm_source=THCB+3.0&utm_campaign=b2d0e4240e-Will+%22Too+Big+to+Fail%22+Come+to+Health+Care%3F&utm_medium=email&utm_term=0_a47e1b8402-b2d0e4240e-19096733

I'll  publish the address of the website for the listing of ideal practices I had previously found when I can find it again. Meanwhile, here's another list of ideal practitioners I just ran across: http://impcenter.org/forums-members-groups/members/

The "Thirteen Arrow Syndrome" -- an analysis of stress on health professionals

This diagram maps some of the more significant stresses on a health professional. I'm grateful to Billie T. Alban for this concept and most of the content. I used the diagram in Intravenous Hope, Stat! As you can see, there are many arrows already, and some professionals will add arrows between elements. For example, patients may harass office staff, so an arrow could go from the former to the latter. Some of the terms in the diagram may not apply to you.

If you and a peer each did a diagram, some of your common items might have connecting arrows stretching from your diagram over to theirs. If you are an administrator, you might have arrows joining staff members' diagrams to items in yours.

Different professions may emphasize different items, and the connections between, say, a nurse's diagram and a physician's could prove consciousness-raising. They might list some items in common, and others unique to their professions. The common items could be a source of support or conflict.

I'll include a quote from the book below the diagram.

    Quote from Intravenous Hope, Sat! 

Key Points About the Role Expectations Diagram Above

In a personal communication, Billie Alban, http://tinyurl.com/d9vwkjj (her book site) lists some key questions that help clarify the binds affecting members of an organization. For each of the persons or groups listed on your diagram, ask yourself:

1. What do they want from me? That is, are staff looking for support for their decisions? Are patients looking for a cure? Is that expectation unrealistic or not? Are hospital administrators looking for more opportunities to bill?

2. How am I responding? Are you putting off unpleasant discussions? Avoiding deadlines? Taking too much of the responsibility on your shoulders instead of delegating? Becoming overloaded with too many duties?

3. Recognize when you can't fulfill an expectation and say why. This boils down to "I can't do that because _____________."

4. Ask yourself: "Do I feel this is a big deal? What makes it big?" This can help clarify priorities and set aside minor issues if other concerns take priority.

5. Recognize when a person needs just a sounding board versus when they need concrete advice. In the first instance, you listen and ask questions to help the person clarify their thinking, their confusion, or their conflict. In the second, you also listen and question but you go on to tell them what you might do, or what you think they ought to do.

End of excerpt from Intravenous Hope, Stat!

When Doctors Don't Know What's Wrong

There's a stimulating article that includes a description by a neurologist of his approach when the workup doesn't point to a specific disease.
See What Doctors Do When They Don't Know What to Do in the blog by Allen Frances, M.D.

Finally got the book up on Kindle and sent announcements. Here's the copy:

To health professionals, their programs, and their families:

I'm a retired psychiatrist in the US.

I hope my Kindle e-book on stress and suicide within the health professions can reach all levels, from student to retiree. The title is

Intravenous Hope, Stat!

We Need to Help Stressed or Suicidal Doctors, Nurses, Psychologists, Therapists and Their Relatives. 

In this book I emphasize support and prevention, while recognizing the despair of those reaching the end of their coping abilities. The "We" in the above subtitle implies that all of us share a responsibility for health professionals' wellbeing.

This responsibility needs to be borne not only by us as professionals, but also by our patients, our family members, and the general public.

Many thanks for distributing this note to those concerned about stress levels in your profession.

Intravenous Hope, Stat! is on this Kindle page.

The book website: www.stressedhealthprofessionals.com

The book blog: http://stressedhealthprofessionals.blogspot.com

Sincerely,

William R. Taylor, M.D. wrbftaylor1@comast.net

Fascinating look inside a doctor's mind!

This link is to a fascinating post that shows how docs and other health professionals ought to think.
http://thehealthcareblog.com/blog/2013/05/30/the-doctors-mind-map/
A whole lot of steps you wouldn't be aware of unless you could read your doctor's mind next time you visit. Dr. Rob Lambert's mind map has a huge number of lines of reasoning, for the care of just one patient.



Intravenous Hope, Stat! now available

Intravenous Hope, Stat!
We Need to Help Stressed or Suicidal Doctors,
Nurses, Psychologists, Therapists And Their Relatives

This e-book is now up on Amazon Kindle at this link
https://kindle.amazon.com/work/intravenous-psychologists-therapists-relatives-ebook/B00DEO5R98/B00DEO5R98  

You can read excerpts on that site, or on earlier posts here, 

or at http://stressedhealthprofessionals.com. 

I will be sending email announcements of the book in the next few days.

First few pages of book for stressed health professionals and their families.

Here are the first couple of pages of the book for stressed health professionals.

Revised 4/11/13

Intravenous Hope, Stat!
We Need to Help Stressed or Suicidal Doctors, Nurses, Psychologists, Therapists And Their Relatives

By William R. Taylor, M.D.

 

Note: If you don't like lists and tables, and are not suicidal at this moment, feel free to skip down to the Preface.  You'll find it right after the table. The Preface opens with this sentence: Working on this book, Intravenous Hope, Stat! introduced me to one of the toughest cases of self-doubt I've ever encountered:

Mine.

I got past those doubts, as you will read later. But first, let me present some concrete ideas about help for those in immediate danger, due to suicidal thoughts or stress reactions.

If You Need Help Right Away

Disclaimer: The statements and suggestions in this book are not intended to diagnose, treat, cure, or prevent any disease. The author does not in any way guarantee or warranty the accuracy, completeness or usefulness of any portion and will not be held responsible for the content of any portion. Always consult with your personal physician for specific medical advice.

If you are thinking about suicide, or are concerned about handling stress, I placed these "If…Then" statements in the table below to help those who need immediate assistance. Some of the resources in this table also appear in other parts of this book, so someone browsing at random might find those resources even if they skipped the table. You may be interested in this preview of a Jackson & Coker survey's recommendations, which appear in the Appendix:

By bringing the problem [of MD mental health issues] out of the shadows and shedding light on what can combat depression or other precursors to suicide, it's possible to rescue those who are on the brink of self-destructive behavior. Raising awareness of physician suicide should be an ongoing process among all segments of the healthcare community.

This book is intended to bring the problem out of the shadows.

Caution

Some readers have been shocked by the table below, which starts at he highest risk level, that is, at a point where a health professional (or any other reader) has already taken a fatal dose of medication or prepared another means of ending their life. Although it may seem unlikely that someone at that stage is reading this, I think we need to face that possibility.

Why start with such a high-risk group, who are unlikely to pick up this book when they are in their final stages of a plan for suicide? On the chance that some of those highest-risk individuals have never talked about suicide with anyone. I want to let those closest to killing themselves know that they might find some hope-- if not somewhere in their lives, then perhaps somewhere in this book.

Why seek hope?

Because one of the most powerful antidotes to the poisonous notion of suicide is at least a small amount of hope. The amount need not be great at the start. A milligram or two can be the initial dose.

Instructions for using the Table

See where you fit in this Table, under IF, and See Suggestions under THEN

IMPORTANT: IF YOU ARE SUICIDAL, AIM TO MOVE YOURSELF TO A LOWER RISK GROUP (FARTHER DOWN IN THE TABLE) FROM WHEREVER YOU FIND YOURSELF RIGHT NOW.

FOR SUGGESTIONS ON HOW TO REDUCE YOUR RISK LEVEL, SEE THE END OF THIS TABLE.

And if you think the mess you're in is too complicated to cope with…also see the end of the table.

I REALIZE I'M ISSUING A NUMBER OF INSTRUCTIONS, BUT IF I DON'T, THERE MAY BE NO ONE ELSE AT THIS MOMENT WHO CAN TELL YOU WHAT TO DO.

TABLE OF POSSIBLE SUICIDE RISK LEVELS

IF	THEN
IF 1. You are a health care provider - or anyone else reading this book -- who has already taken the overdose you had planned to kill yourself with, or who is about to commit suicide by some other means, see next column	Call 911 or the local emergency number in your location. Or call a suicide hot line. One Hot Line number is 1-800-SUICIDE (1-800-784-2433) Another is 1-800-273-TALK (1-800-273-8255). If those numbers have changed, the website is www.suicidehotlines.com Tell them where you are and what you have taken or are about to do. THEN DO NO FURTHER HARM TO YOURSELF. FOLLOW THE INSTRUCTIONS YOU RECEIVE FROM THE HELP LINE STAFF. WAIT FOR HELP TO ARRIVE. Why do this? Because you need to move yourself to a slightly lower level of risk in this table of suicidal behavior. You're (obviously) at the highest risk of death and need to move to a lower risk level in order to take another look at your suicidal plans. Note that I am not asking you to give up plans for suicide, but to move to a lower risk level, at least for now. You can reduce stress by identifying some of the factors in your stress list (long list in Chapter 13.) You can also "work yourself up" as suggested in Chapter 2.
IF 2. You are a health care provider (or anyone else) planning to kill yourself and have collected materials needed 3. You have set a time and place for your suicide 4. The time you have selected for your suicide is within a few minutes to a few hours from now	Then, realizing that we have no relationship other than writer and reader, I ask you to do the following: 4A. Delay your suicide (I realize that I probably don't have enough influence with you -- yet -- to ask you to cancel your plans.) 4B. Talk about your suicide decision with a ·       Trusted friend ·       A prescribing physician who can help you decide to try antidepressants, or change you to a different dose or different medication or can discuss Transcranial Magnetic Stimulation (TMS), which might work when antidepressants have not ·       Or psychotherapist ·       Or colleague ·       Or member of the clergy Or call a suicide hot line. One US Hot Line number is 1-800-SUICIDE (1-800-784-2433) Another is 1-800-273-TALK (1-800-273-8255). If those numbers have changed, the website is www.suicidehotlines.com ·       I found a variety of international hotlines on Google, searching under "worldwide suicide hotline numbers." However some did not have listings for all the headings they presented. This site seemed promising (in March 2013) Includes Canada http://suicideprevention.wikia.com/wiki/International_Suicide_Prevention_Directory Or check other help lines (in phone book or on Internet) ·       Or you can find many other help lines and sites in this book below by following this link ·       Or talk to a member of your family -- recognizing that not everyone has a family, or the kind of relationship where you would inform them of a plan for suicide. 4C. As I said at the top, if you have already taken the overdose or other steps to kill yourself, call 911 or the local emergency ambulance number in your location.
ON THE OTHER HAND, IF… 5. The time you have selected for your suicide is farther off, but within the next few days 6. You have told no one about your plans	THEN, Realizing that we have no relationship other than writer and reader, I ask you to do the following: A. Follow one or more of the suggestions in part 4B above B. Take a look at the Table of Clinicians' Stresses and Possible Sources of Support in the Appendix
ON STILL ANOTHER HAND, IF… 7. You have told or hinted to someone about your plans, or feelings about killing yourself (told a psychotherapist, member of the clergy, family member, friend, colleague, suicide hot line, or other source of help)	THEN A. Have they believed you? B. And are you or they taking action to keep you alive? C. Do you think that plan will be enough to keep you alive? D. If you answered "No" to A, B, or C, then find another person to talk to in the list in number 4 B above IF THE FIRST PERSON YOU TALK TO DOESN'T UNDERSTAND OR TAKE STEPS TO KEEP YOU ALIVE, TALK TO SOMEONE ELSE OR CALL A DIFFERENT HOT LINE E. Take a look at the Table of Clinicians' Stresses and Possible Sources of Support in the Appendix
ON STILL ANOTHER HAND (Your fourth hand, if my count is right) You have thought about suicide, but your situation fits OTHER POSSIBILITIES (to next column)	OTHER POSSIBILITIES, such as 8. You have thought about suicide but have no specific plans 9. You have thought about suicide but have decided to wait till after a particular event (someone's birthday, a holiday, etc.) THEN You need to discuss these thoughts with one of the people in number 4B above Or Take a look at the Table of Clinicians' Stresses and Possible Sources of Support in the Appendix
OR Number 10 or 11 applies to you	10. You find yourself under excessive stress, but have no thoughts about suicide, or changing jobs within your profession, or leaving your profession. THEN parts of this book, such as Chapter 2, Chapter 3, or Chapter 4, might be helpful OR 11. You are under excessive stress and wondering whether you could change jobs within your profession, or leave the profession (retire early, change to something you always wanted to do.) You can read about people who have made such decisions in Chapter 10 or in the Appendix. OR Take a look at the Table of Clinicians' Stresses and Possible Sources of Support in the Appendix
OR 12. You are a family member, friend, or colleague of a health care provider who you think could be suicidal OR 13. You are a family member, friend, or colleague of a suicidal health care provider who has tried suicide and survived OR 14. You are a family member, friend, or colleague of a health care provider who has killed himself or herself.	THEN you might find Chapter 6 helpful. There are other self-help books or sites, such as: http://www.metanoia.org/suicide/ http://www.amazon.com/Power-Prevent-Suicide-Guide-Helping/dp/1575422069  (where several books are described; if you do not feel comfortable shopping for such books at a local bookstore, you can order them online.)
15. FINALLY, IF you don't fit any of the above descriptions;	I hope you will try to understand how stressful life can be for health professionals, some of the men and women you will meet in this book. The above items might fit some of them, and these items might be helpful to you, if you feel suicidal, even if you're not a health professional.
REDUCING YOUR RISK LEVEL -- a few suggestions about where to look in this book	Work yourself up via Chapter 2; Read my challenge of the reasons you're not getting help for your emotional or unemotional state (Chapter 4); take a look at your alcohol or drug use via Chapter 14; challenge your idea that your family would be better off without you (Chapter 15); take the same challenge regarding co-workers and patients (Chapter 16) I'll repeat some of these suggestions later. And in case you missed this above,Take a look at the Table of Clinicians' Stresses and Possible Sources of Support in the Appendix
And if you think the mess you're in is too complicated to cope with…	…you're right! The challenges you face as a health professional are far worse than anything our poor brains have evolved to cope with over the last ten or twenty thousand years. But maybe we can muddle through some of this mess together.

The following is a copy of letter sent to Columbia University College of Physicians and Surgeons, Class of 1960. If you're from another class, or another school, or another health-related profession, please feel free to comment.

Greetings from Bill Taylor, P&S '60
I'm writing to classmates with email addresses in the P&S Class of 1960 reunion book, to say hello, and to ask a question.

First, the hello. Barbara and I are happy in a CCRC in Bloomfield, CT, just outside of Hartford. It's one of those places with a continuum of care that enables residents to get the support they need as they age. We enjoy the variety of people and activities, and the chance to be occasionally of some support to those who need it. We're lucky in having children and grandchildren in the East and in Colorado. I've self-published some non-fiction and a couple of collections of fables, mainly as e-books, but haven't done any marketing.

I recommend to any of you who haven't gotten around to writing those memoirs or that other writing or graphics project you've been thinking about -- go ahead! I'm sure you know how easy it is to do an e-book these days. Your family and friends will appreciate what you have to say. Even if you "don't feel like it," at the moment, try going ahead anyway. See if you begin to get into it as you go along. I think we all have something to say, if we have a bit of encouragement. I was very impressed by the range of experiences reflected in the class notes in the Reunion book, and I'm sure you have a lot more to say.
My other reason for writing is related to having "something to say."

Along those lines, I think we've all had a lot of experiences that could be helpful to younger health professionals. Would you be interested in contributing ideas about the impact of stress on us at various stages of our lives, describing the ways we coped -- and are still coping?

As you know, some over-stressed health professionals get the point where they may feel at least transiently suicidal. Of those, some go on to end their lives.
The aim of this effort would be a book and a website that might persuade some stressed and even suicidal doctors, psychologists, nurses, and other health professionals to get help and reconsider their decision. I have a rough draft of the book, have recruited two local colleagues, and have just started a blog, as a possible channel over which health professionals in distress could seek support and provide encouragement to one another.
I have not been able to find any books specifically aimed at prevention of suicide by health professionals. (If anyone knows of a preventive site or book for health professionals, please send me the address. There are several sites where residents and others write about their frustrations.)

P&S and other med schools have placed a number of supportive resources on the Internet, as you may have discovered.

Goal of this project:
I think medical professionals of all disciplines would be interested in any advice you have for those students, residents, and graduates who are stressed and sometimes demoralized by all of those present-day challenges we know about.

For example, they might be interested in your thoughts about such a question as one (or more) of these:

Have you taken part as a mentor in programs that aimed in part at emotional support? If you were a teacher or supervisor, what helped those in the class or group to weather stress?

What advice would you give to anyone who wants to start such a support group?

What ways of coping have you found helpful?

Were there people or writers who you found inspiring when you felt stressed?

Did you have ways of unwinding?

Did your family play a supportive role, and if so, how?

Did relations with colleagues help or hinder your coping? Did you learn from some of them?

What in your experience at P&S was useful when it came to coping with stress later on? What was not so useful?

Do you have a personal physician or other professional who is supportive?

Were there times when you considered seeing a therapist, or did consult one?

Anyone you know who struggled with suicidal thoughts or made an attempt? Did the person succeed. If they survived, did their life change?

Responses to these questions, and any other thoughts would be most welcome. Is email a good
way to communicate? If you would prefer, you can also post on the website.

Background information:

As you may be aware, there is often silence about suicide, especially when the medical community encounters such an act by one of its own. There are some research articles on suicidal doctors as a group, but only one or two books, to my knowledge: accounts by doctors of their own suicide attempts that "failed." (This relative scarcity of books by health professionals contrasts with the large number of posts and books about suicidal feelings and acts by the general public.)

A small number of family members have written articles about their experience after their doctor-spouse or their doctor-parent killed themselves.

There are also an increasing number of suicide prevention programs by medical societies and licensing bodies.

Nevertheless, some writers have emphasized the many barriers to a depressed, exhausted doctor's asking for help, and pointed out the need for more research and a focus on prevention.

I would see the book as a self-help guide aimed at supporting strengths, resilience, and coping skills.

Although I have not been suicidal myself, I have had enough stress during my years in medical school, and then in residency and in practice, to empathize with students, clinicians, faculty members, or hospital administrators who decide to end their suffering, once and for all.

I've also had a niece who killed herself in her early twenties (around 1995), and an uncle (not related to the niece) who suicided some time in the nineteen-fifties. There may well be a genetic risk in the family tree.

In mentioning these personal and family stressors, I guess I'm trying to send a message that we as a profession don't need to be quite as reluctant as we often are to discuss such matters.

What do you think?

Finally, I want to say that I think back to medical school with fondness for the collegiality, stimulating environment, and relatively sheltered existence (even with the academic competition), way back before we knew about managed care, liability insurance, hospital politics… But you have your own list of stressors, I'm sure.

Looking forward to hearing from you.

Kind regards,
Bill Taylor P&S '60
The blog is http://stressedhealthprofessionals.blogspot.com/

My email is wrbftaylor1 at comcast.net (replace "at" with @ and remove spaces)

If you would like to share your message with others in the class of '60 please use the "Reply All" button. I will of course keep all replies confidential if they are sent just to me. You can also reply on the blog, in the "Comments" section.

New book and blog on stressed and/or suicidal health professionals

Trying out this new blog as a possible accompaniment to a book on stress and suicide in health professionals: doctors, nurses, psychologists, therapists. The book is tentatively titled
 

Intravenous Hope, Stat!
We Need to Help Stressed or Suicidal Doctors, Nurses, Psychologists, Therapists And Their Relatives 

There appear to be few books aimed at reducing the elevated rates of suicide by helping professionals. There are many websites with excellent advice on decreasing stress and reducing the urge toward suicide.

I'll post more information here as the project develops. 

Comments? Please email or post here.

wrbftaylor1 at comcast.net (replace "at" with @ and remove spaces)