April 9, 2019
On its “All Things Considered” program and in its “Shots” blog, NPR reported that healthcare workers have been frequent targets of violence against them from patients and their families. OSHA statistics note that incidents of serious workplace violence are four times more common in health care than in other work environments. This is not new information, but really old, info well-known internally that is being made public.
January 27, 2019
A team of social psychologists studied the effect that bedside manner has on patient outcomes. Not surprisingly, patients not only prefer to have a nice doctor who spends a couple extra minutes with them, talks to them as people rather than CPT or RVU numbers, etc., but they actually get better quicker.
In my work with disruptive physicians, I frequently hear that the reason why doctors are gruff (or worse) with their colleagues is because they are looking out for patient care (in contrast to their perception that others on the treatment team are not). These physicians often see significantly more patients than their peers, move faster than others, and talk over people… and they don’t always slow down enough so that their patients feel listened to and understood.
So, perhaps we should all slow down a bit, get our noses out from the screen and pay attention to our patients. It’s good for them.
January 1, 2019
I recently came across this interesting article about physician burnout. It was a nice review of the relevant literature. The authors addressed the obvious issues such as job dissatisfaction, turnover and related financial and career-related issues. They also did a really good job describing the correlation between physician burnout and medical errors (and malpractice claims), something that most burned out doctors often don’t think much about. Somewhat related to this, it seems that patient satisfaction is negatively affected by burnout. Demographically, women are more prone than men to burn out, as are younger physicians.
Burnout is often not addressed until bigger, more damaging problems arise, such as acting out with disruptive behavior. As with most compounding problems, it’s much easier to prevent or successfully treat disruptive behavior when underlying burnout issues are dealt with. I’m available to meet with such physicians and other healthcare professionals. Contact me to schedule an initial consultation.
August 9, 2018
A study was published in Lancet Psychiatry yesterday that added to the evidence that exercise is good for one’s mental health. In this study, participants rated their mood nearly 1.5 days per month less if they exercised compared to similar people who didn’t exercise. Those who engaged in team sports, cycling and other exercise with durations of 45 min and frequencies of three to five times per week reported the best effects.
None of this is really new, but the study supports previous studies that show clear and definitive mental health benefits of regular exercise.
June 7, 2018
In a blog post from a few years ago about the dose-effect of exercise, I passed along the findings that nearly an hour of rigorous exercise, at least three times per week, can be as effective as antidepressant medication.
A newly published study notes that resistance exercise (such as lifting weights) can be useful in reducing depressive symptoms regardless of the intensity, duration or frequency of the workouts. So, go out and pump some iron to strengthen your resistance from depression! Even short, infrequent or not very rigorous workouts are helpful.
May 8, 2018
An interesting study was recently presented at the ApA conference: there is now limited testing available to determine which SSRI or SNRI antidepressant medication is more likely to work for you based upon your genetics. The study was funded by the testing company, but is worth looking into for more information. Hopefully this will prevent the “hit or miss” experimental approach of selecting antidepressants based upon side-effect profiles, and waiting 2-6 weeks to find out if the clinical guess was a good one or not. The article is on Medscape (you might need to register for a free account to access it).
March 7, 2018
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And please read more about my work with disruptive physicians, healthcare workers and other professionals.
August 16, 2017
The CDC’s National Center for Health Statistics just put out a report about the increasing use of antidepressants. As a psychologist (as opposed to a psychiatrist), I have mixed feelings about this. On the one hand, there have been many studies that have demonstrated the superior or at least matched efficacy of psychotherapy over medication to treat depression and anxiety, so I find this trend concerning. But on the other hand, when I recommend that some of my patients should consider consulting with their primary care provider or a psychiatrist and they express concerns about stigma, weakness or other reasons not to consider this treatment option, I attempt to reassure them that “antidepressants are one of the three most commonly used therapeutic drug classes in the United States” according to the report, and thus they should not feel self-conscious about taking such medications.
The report noted that there has been a progressive increase in antidepressant use since 1999, and that during the time of the study, nearly 13% of people over the age of 12 in the US have reported taking antidepressants in the past month. Women take antidepressants at double the rate of men. A quarter of those who reported using antidepressants have taken them for at least ten years.
It’s reassuring that those who need to take medication are in good company, but it is important to explore non-medical treatment of depression and anxiety, as the beneficial effects tend to be of a much longer-lasting duration.
December 19, 2016
A recently published meta-analysis of over 3000 studies suggested that switching antidepressants after the first drug doesn’t produce the desired results is not better than staying the course and/or exploring options other than trying a different drug. This is a very interesting finding as most prescribing clinicians tend to give one antidepressant a “trial” of about 6-12 weeks. If things aren’t better then often scrap that medication and start another 6-12 week trial of another one. The authors of this article reviewed 3234 relevant studies and concluded that it is generally wiser to explore alternatives other than a medication change.
December 13, 2016
A recent research letter, published by JAMA, reported that one out of six American adults take at least one psychiatric medication. As a clinical psychologist I understand the benefits of non-medical treatments for psychiatric illness, but that doesn’t mean I don’t appreciate appropriate use of psychiatric meds. In fact, I refer a significant number of my patients to their primary care providers or to psychiatrists for medications, and I often make suggestions to the prescribing professionals about which medication I believe would work best for the referred patient. Nearly every time I do this, however, I have a long discussion with my patient about what it means to be on a psychiatric medication, and what it doesn’t mean. I almost always say something like, “several of your friends and several of your coworkers are on [psychiatric] meds… but they just haven’t told you,” in an effort to communicate how prevalent they are. This letter drives that point home really nicely.
But what I really like about the letter is that it also talks about how some medications are not be prescribed appropriately. Two classes of drugs that are most frequently mis-prescribed are benzodiazapines (e.g., Ativan, Xanax) and sedative/hypnotics (e.g., Ambien), which are supposed to be used short-term, not for months or years at a time.