burnout in medical education

The New York Times published an article yesterday about burnout and suicidal ideation among medical students. No one is surprised that medical school is hard. That’s perhaps an understatement. But combine the massive amount of information you are supposed to absorb with an ultra-competitive environment, and the thought that complete failure is just one slip-up away, and you have a group of students ripe for complete burnout or worse. The other implication of this is that such completely burned out students lose the ability or desire to empathize or effectively communicate with their patients. They are just trying to get through the day.

The question is whether anything can be done about this. Medical school is hard. There is a vast amount of information you simply have to learn in a limited period of time. Practicing medicine is hard. There are a million decision that need to be made, many of them a matter of life or death. There is nothing you can do to change that. But can or should medical school try to change or soften the environment in which the students learn?

The comments on this article were varied; everything from those who exhort students saying “Medical school is hard. Deal with it, quit whining, or find another profession,” to those who believe the model for how medical students and residents are educated must be completely turned on its head. Is it a matter of screening incoming medical students better to measure who will be able to handle the high-pressure environment or is it a matter of monitoring students mental health better before the stress gets dangerously high? But if such burnout impacts the students’ ability to ultimately practice medicine, most would agree that something needs to be done.

You can find the article here: http://www.nytimes.com/2008/10/31/health/chen10-30.html?partner=permalink&exprod=permalink

And the comments here: http://well.blogs.nytimes.com/2008/10/30/the-misery-of-the-med-student/

Health messages through song

The New York Times ran an article Saturday about Feliciano Dos Santos one of southern Africa's most popular singers, who writes and performs songs promoting sanitation and disease prevention. It is an interesting look at health promotion in a different culture and also examines the barriers to health promotion. Health promotion is about more than getting health messages to the people, but addressing the cultural and systematic barriers to changing behavior.

You can find the article here: http://www.nytimes.com/2008/10/25/world/africa/25santos.html?partner=permalink&exprod=permalink.

Literature and medicine

The New York Times published a compelling article today about the growing use of literature courses in medical school and residency programs. The courses are intended to help physicians grow and foster empathy for patients. And there is growing research that the programs work.

You can find the article here:http://www.nytimes.com/2008/10/24/health/chen10-23.html?partner=permalink&exprod=permalink

And the comments here: http://well.blogs.nytimes.com/2008/10/23/combining-literature-and-medicine/

One of the most compelling comments was that these courses are indeed valuable, but they should be taught by literature professors, not medical doctors. But some of the doctors who commented on the article disagreed, saying it was more important to emphasis the relevance to the patient narrative rather than literary technique. Like the literature professor, I have sometimes wondered about the fact that M.D.s rather than communication professors teach medical students communication skills. It is not just that literature professors or communication professors hold specialized knowledge about their topic, which they certainly do. It is about the fact that professors from outside the medical field bring a new perspective and push medical students to get beyond thinking like doctors and get them to think as members of the human community. Senior physicians can certainly guide young physicians in how to pull all they have learned together in the patient setting. It seems that if we want a doctor that is technically astute and also expressive and empathetic, there has to be many teachers and many different kinds of textbooks to make that happen.

Patients' stories in their own voice

While at the AACH conference, I heard about a great resource for patients, health care providers and researchers, organized by the DIPEx research group at University of Oxford. The web sites http://www.healthtalkonline.org/ and http://www.youthhealthtalk.org provide patient interview videos and transcripts of patients talking about the many facets and implications of living with a particular disease. Diseases are indexed so that a new patient or a physician seeking to better understand the patient experiences can seek stories by topic. Researchers can access the material as well to gain a broader look at living with a particular illness.

Patient stories provide a unique perspective, especially to new patients, by providing technical information as well as insight into the emotional toll of an illness. And the volume of stories on these two web sites offers a dramatic look at human element of health and illness in a way that you just can't capture in text.

Positive medical experiences

I had a chance to meet and chat with Dr. Shailia Jain, founder and moderator of http://www.thebedsidemanner.com at the AACH conference in Madison last weekend. She started the web site because she wanted a place where people could record their positive experiences interacting with physicians and other health care providers, as well as their hopes for how the provider-patient relationship could improve. With so many bad examples on the Internet and elsewhere, this web site seeks to give physicians a place to learn from good examples and aspire to do better. Check it out.

Counting words

The New York Times published an article earlier this week about Dr. James Pennebaker, a psychologist who counts and studies words and leads a resurgent interest in text analysis. It is a fascinating approach to studying communication, by looking at individual words and patterns among people who use particular words.

You can find the article here: http://www.nytimes.com/2008/10/14/science/14prof.html?partner=permalink&exprod=permalink

And speaking of innovative communication research, I am looking forward to heading to Madison tomorrow for the American Association on Communication in Healthcare Research and Teaching Forum http://www.aachonline.org/programs/aachforum. It should be a great conference and I'm sure I'll be bursting with ideas come Monday.

A book that is good for your help

The New York Times printed an article yesterday about a study out of Duke University. The study examined whether fiction books with health messages impact the health of the young girls who read them. There is some indication that the books with healthy messages certainly don't hurt and may even help.

You can find the article here: http://www.nytimes.com/2008/10/14/health/14well.html?partner=permalink&exprod=permalink

The article generated considerable discussion about the value of hiding messages in entertainment novels and other ways to influence children's health decisions. You can find the discussion here: http://well.blogs.nytimes.com/2008/10/13/books-for-girls-with-a-health-message/.

So what do you think of the approach? Is it just preaching that most girls will ignore? Is it potentially useful? What might work better?

The choices patients make

This article is from last Thursday, but I still wanted to point it out. Dr. Pauline Chen writes in The New York Times about the choices patients make and a new book called Sick Girl by Amy Silverstein. The book offers explores the patient's perspective of being chronically ill. While their lives may have been saved by life-saving procedures such as transplants, they still have to deal with being sick each and every day of their lives. This leads to mixed emotions of being grateful for life but frustrated by life at the same time. And many times, chronically ill patients feel like they cannot express the frustrations and anger about their illness because of expectations that they should be optimistic.

You can find the article here: http://www.nytimes.com/2008/10/10/health/10chen.html?partner=permalink&exprod=permalink

And the discussion here: http://well.blogs.nytimes.com/2008/10/09/the-choices-patients-make/

The power of language

The New York Times published an article about the power of language as it relates to elderly patients. A study to be published in The American Journal of Alzheimer's Disease and Other Dementias found that "elderspeak," belittling language directed toward the elderly, may cause psychological harm. Such language includes referring to elder patients as "sweetie" and "dear" rather than by a courtesy title or behaviors such as discussing the elder's health with an adult child rather than the elder. The psychological harms comes when people mutely accept the attitudes behind the language and develop a negative perception of aging. Those with a negative perception of aging have worse functional health over time.

You can find the article here: http://www.nytimes.com/2008/10/07/us/07aging.html?partner=permalink&exprod=permalink

And the discussion here: http://newoldage.blogs.nytimes.com/2008/10/06/how-not-to-offend-the-aging-a-primer/

The study raises interesting questions about the power of language and the responsibility to communicate with elderly patients in a respectful way. What do you think? Are there other communication relationships and behaviors that have the potential for psychological harm?

A new approach to recruiting healthy research subjects

The Dr. Susan Love Foundation and the Avon Foundation have partnered to take a new approach to recruiting healthy research subjects. They have launched a high profile campaign called the Army of Women to recruit 1 million healthy women to participate as healthy volunteers in breast cancer research. The foundations are also hopefully that more scientists will work on preventative breast cancer research with the available healthy volunteers. Interested women fill out a short profile on the web site and are notified by e-mail of studies in need of volunteers. The women who fill out the profile are not obligated to participate in any of the studies sent to them and the final decision to participate is still left to the individual.

This is an innovative new approach to recruiting healthy volunteers and the images and words on the web site certainly tap into the altruistic reasons that motivate some people to participate in research. In the process, it seems it may also educate more people about the clinical research process.

So check it out: http://www.armyofwomen.org/ The web site includes some current ongoing research, combined with some compelling stories and images.

What do you think of the approach?

Being a bad patient

CNN recently interviewed actor Evan Handler who says being a "bad patient" can save your life. Drawing from his own experiences, Handler says that patients should double check everything, ask questions, and be your own advocate, even at the risk of annoying your physicians and being labeled a "bad patient." Such vigilance can save your life.

You can find the article here: http://www.cnn.com/2008/HEALTH/10/02/ep.evan.handler.patient.advocate/index.html

So what do you think? What behaviors or actions do you think patients should take that may be perceived as "bad behavior" by physicians?

Deciphering medical studies

One of the articles in the Decoding your Health series that ran in The New York Times yesterday was an article about how to decipher medical studies. It does a great job of explaining the different types of medical trials and studies, and illustrates the differences using examples.

You can find the article here: http://www.nytimes.com/2008/09/30/health/30stud.html?partner=permalink&exprod=permalink