Upcoming Teacher's Training
Those of you who are in health care education (residency, fellowship or medical school) may also be interested in our second annual
Finding Balance Teacher Training Program
Petaluma, California
July 19 - 23
 
Over 15 residencies and medical schools are using the Finding Balance curriculum. This is your opportunity to bring healthy curricular material to your institution and broaden your capacity as a teacher.

This 5 day teaching program will cover core areas of research on physician health, personality structure and interpersonal function. It is designed to train each participant to be a facilitating teacher in the area of physician and medical trainee health. Participants will be trained to teach both small and large group classes in the area of physician health as well as to lead seminars in this area.

For curriculum details, information and to register, click here.

The New Generation of Docs; Slackers or Realists?
The resident that walks into your practice as a new employee this year is very likely to have a different attitude towards work than you have. They are likely to want time off for family, evenings free and plenty of vacation time. Your response may simply be;
"I never had it that good, why should you?" You may see them as a problem and part of the 'slacker' generation.

Who is right, a doc that wants down time with family or one who dedicates themselves to medicine regardless of the costs? Statistics have shown that for the latter:

There is a 67% burnout rate (1)
A 38% rate of dissatisfaction with their work (2)
Higher than average cardiovascular death rates and suicide rates (3)
High rates of depression (4)
Other publications have shown that physicians who make time for family, spiritual growth, and volunteer work are happier and healthier (2, 5).

"Physicians who manage their own stress and feel happy
with their own daily circumstances are probably better physicians,"
American Medical Association President Ronald Davis.

My belief is that, as medicine changes, we must change as well. The style of practice that worked for physicians 20 years ago no longer works for most physicians. This style includes being the sole decision maker who fails to delegate, and who insists on being available 24 – 7. With increasing demands on physician's time, the growth and aging of the population, and the relative decrease in the number of physicians per capita, (especially in primary care,) it becomes impossible to maintain the 'old' style of practice (6).

The new style of practice includes:

An integrated team approach using other physicians and clinical team members
Flexible schedules
Accepting less continuity and using hospitalists
Electronic medical records for ease of access to information
Equal pay for equal hours worked
Between 1996 and 2003, the proportion of women graduating from U.S. medical schools who chose more "controllable" lifestyles — specialties allowing them to dictate hours spent on the job — doubled. Those opting for more flexible fields rose to 36% from 18%, according to a 2005 study published in the journal Academic Medicine. For men, it rose to 45% from 28%, the study showed (6).

In the business literature the number one contributor to work satisfaction is enjoying the work you do day to day. My concern with choosing your specialty based on lifestyle is that it will quickly lead to work dissatisfaction, as you are less likely to enjoy day to day working.  I believe this too is a mistake that many young physicians are making.

The short term solutions are to create more flexibility in practice options, greater pay for primary care docs for the patient management work that they do, such as the medical home concept, and to accept that the world of medicine has changed. The long term solution, besides the ones stated in the bullets above, is to educate more doctors and clinicians who will share their work as integrated teams.

From my stand point, there is no right or wrong. The young generation of physicians has as much to teach us as we do them.

The American College of Physician Executives, The Physician Executive, December 2006
E. Frank, McMurray J. E., Linzer M., Elon L., "Career Satisfaction of U.S. Women Physicians: Results from the Women Physicians' Health Study", Archives of Internal Medicine 159 (July 12, 1999): 13
Erica Frank, Holly Biola and Carol A. Burnett, "Mortality Rates and Causes Among U.S. Physicians", American Journal of Preventive Medicine, Volume 19, Issue 3, October 2000, Pages 155-15
C. Center, et al., "Confronting Depression and Suicide in Physicians: A Consensus Statement", Journal of the American Medical Association, 289 (2003): 3161–166
Rein Lepnurm, DrPH, Roy Dobson, PhD, Allen Backman, PhD, David Keegan, MD, "Factors Explaining Career Satisfaction Among Psychiatrists and Surgeons in Canada", Canadian Journal of Psychiatry, March 2006
J. Goldstein, "As Doctors Get a Life, Strains Show Quest for Free Time Reshapes Medicine; A Team Approach", The Wall Street Journal, April 29, 2008
Just for fun
Eat, Pray Love by Elizabeth Gilbert
OK, it's tough as a guy to recommend a 'chick' book, but I read it en-route from Asia and loved every minute. If you have a fondness for India, Bali or Italy, it's a must read. If you don't, this book is a personal travelogue through these countries that will make you want to buy a ticket! Enjoy the journey.


Lee Lipsenthal, MD, ABIHM

 
 

here are a few spaces left for our upcoming program:
Finding Balance as a Healer
Molokai, Hawaii
May 25 – 31
For more information (link to registration page)

Here's your last chance to sign up for a learning trip in paradise. A beautiful, simple setting on the quiet island of Molokai with amazing food…and waking up to the sound of tropical birds!
 

Those of you who are in health care education (residency, fellowship or medical school) may also be interested in our second annual:
Finding Balance Teacher Training Program
Petaluma, California
July 19 - 23
To register or for more information call Larry Cooper, 1-800-769-0639 or healthcl@silcom.com
 
Our mission is in this course is to train Health Care Educators in the Finding Balance in a Medical Life curriculum. This five day teaching program will cover core areas of research on physician health, personality structure and inter-personal function. It is designed to train each participant to be a facilitator teacher in the area of physician and medical trainee health. Participants will be trained to teach both small and large group classes in the area of physician health as well as to lead seminars in this area.

For curriculum details, information and to register click here.


How healthy are you?
The American Board of Integrative and Holistic Medicine (HolisticBoard.org) has been using a fantastic personal health assessment for many years now. It brings together emotional, physical, mental and spiritual health in an easy to use questionnaire.

I have made it available to you, in a printable PDF format, for your personal use and for use with your patients. Good luck on the test! Let's see how you do.


For your listening pleasure
As always, it is my desire to expose you to new and great music. I just purchased the CD called In the Name of Love: Africa Celebrates U2. This is a CD of brand-new covers of classic U2 songs by Grammy Award-winning and up-and-coming African artists including Angelique Kidjo, Les Nubians, Sierra Leone's Refugee All Stars, Vieux Farka Touré, Vusi Mahlasela and the Soweto Gospel Choir. The album was inspired by Bono's direct philanthropic impact via the launch of the ONE campaign and (RED), and his poignant outspoken public commentary on the immediate financial needs facing Africa.

It is fantastic!


We welcome your feedback on the information we provide, as well as any
questions you may have about our programs, and how they may be of help
to you and your staff. My email is: lipsenthal@aol.com

Best in health for you and your patients,

Lee Lipsenthal, MD, ABIHM

 
 

Visit us at  www.findingbalanceproductions.com; Email to us at healthcl@silcom.com

  Welcome to Finding Balance eNews. Please note that we have an upcoming program in San Diego, April 12 & 13th as well as a week long program in Molokai Hawaii, May 25th – 31st.


For other information on On-Line CME, Books, CDs and programs, please visit FindingBalanceProductions.com


Catch Some Zs


Some of you may be familiar with the expression to catch a couple of Zs. This is derived from the use of the letter Z in comic strips to indicate sleeping. Apparently we docs are not catching enough Zs!


In a randomized, internet-based questionnaire, the American College of Chest Physicians Sleep Institute (ACCP-SI) surveyed 5,000 US physician members about current sleep habits and how sleep affected work and day-to-day performance (1). Of the 581 respondents, 70 percent reported needing at least 7 hours of sleep to function at their best during the day, yet physicians reported sleeping an average of 6.5 hours on a workday.


Physicians reported "making up" for lost sleep on the weekends or days off by sleeping an average of 7.5 hours a night. Furthermore, 43.1 percent of physicians indicated their current work schedule did not allow for adequate sleep. Physicians rarely reported insomnia or difficulty initiating or maintaining sleep. However, 21.8 percent reported not feeling refreshed upon waking at least a few nights a week.


Most physicians indicated that sleep issues did not significantly impact work performance or other daily activities. However, 18 percent of physicians reported missing at least one family or leisure activity due to sleep issues.


In an earlier article, reported in Internal Medicine News, it was stated that 52 percent of 500 primary care physicians randomly surveyed by telephone reported have sleep difficulties, averaging 15.8 nights of sleep difficulty/month. When you further analyze the difficulties: 20 percent took an average of 26 minutes to fall asleep, 19 percent dozed off while driving and 20 percent used sleep agents at least twice per month.


This is concerning for our long and short term health. The short term concern is falling asleep while driving. While you may consider this a rare event, I suspect that you can remember at least one time arriving home or to the hospital and not remembering how you got there. It is also likely that you caught yourself dozing off while driving, awaking quickly to catch yourself.


The long term ramifications are also concerning. Too little sleep may raise the risk of developing heart disease. In the nurse's health study, women who averaged five hours or less of sleep a night were 39 percent more likely to develop heart disease than women who got eight hours. Those sleeping six hours a night had an 18 percent higher risk of developing CAD than the eight-hour sleepers (3).


Lack of sleep is associated with hypertension, elevated cortisol and catecholamines, lower glucose intolerance and lower heart rate variability, all of which are associated with increased CAD risk.


In summary, we tend to under-value and under-estimate the importance of sleep – please catch some Zs!


American College of Chest Physicians (2008, March 5). Most Physicians Sleep Fewer Hours Than Needed For Peak Performance, Report Says. ScienceDaily. Retrieved March 6, 2008, from http://www.sciencedaily.com/releases/2008/03/080304075723.htm
 
Dr. Thomas Roth, Ph.D., Chief of the Division of Sleep Disorders Medicine at the Henry Ford Hospital in Detroit (Internal Medicine News, 12-1-96, pg. 1).
 
A Prospective Study of Sleep Duration and Coronary Heart Disease in Women Najib T. Ayas, MD; David P. White, MD; JoAnn E. Manson, MD, DrPH; Meir J. Stampfer, MD, DrPH; Frank E. Speizer, MD; Atul Malhotra, MD; Frank B. Hu, MD, PhD, Arch Intern Med. 2003;163:205-209.

Just for fun


I've been listening to a lot of Joshua Radin recently. I first heard him on the sound track of the movie, The Last Kiss as well as on the Scrubs soundtrack. His voice is very reminiscent of Art Garfunkel's (of Simon and Garfunkel), sweet, whispery and soft. For a great sample check out the song Star Mile on the album We Were Here. Highly recommended!



Thanks for reading,

Lee Lipsenthal, MD, ABHM

 
 

Visit us at  www.findingbalanceproductions.com; Email to us at healthcl@silcom.com

Welcome to the first Finding Balance Newsletter of 2008. Many of you have already accessed Finding Balance's CME On-Line. Thanks for using this fun way to get CME at home. For more information on Finding Balance in a Medical Life programs, training and products go to FindingBalanceProductions.com .

This months' topic:

Keeping up with the literature; a broken paradigm

Do you have a pile of journals at your bedside or desk side? Do you feel guilty that you haven't read them?

A close friend of mine told me about a scenario that occurred after the death of his father, a prominent psychiatrist. When my friend and his family were cleaning out his father's house, they found journals scattered all over. They could not believe the number of journals that his father had kept (read or unread). On the second day of cleaning, they found a walk-in closet that contained thousands of journals, some of them never opened.

We all hold the belief, to some degree, that in one of these journals lies some wondrous pearl of wisdom that will make us a better doctor or help solve a patient's problem in the future. My question to you is; how will you find that pearl of wisdom in the mess next to your desk in anything less than twelve hours?

In the 1940s there were three major medical journals in the United States . All three were monthly subscriptions, two of which were newsletters. Keeping up with the literature meant pouring yourself a coffee on a Sunday, sitting in your comfy chair, and reading for an hour or two. Many of your professors grew up with this paradigm; keeping up was critical and possible.

Since that time, the volume of medical literature has grown exponentially. More research is being done worldwide, and it is more accessible than in the past. In addition, the average physician receives multiple journals, including throwaway journals, weekly. It is impossible to keep up with the literature anymore, yet when we see the overwhelming pile next to the bed, we feel incompetent as physicians and scientists. After all, we were told, "If you don't keep up with the literature, you are not enough". One colleague of mine was told, "If you don't keep up with the literature, people will die." This creates anxiety and frustration for us all.

Today we all have an incredible, inexpensive resource: it's called the Internet. It is now possible to find the answer to a problem, if one exists, in minutes. It is also possible to reassure yourself if no answer exists.

Let go of the old paradigm of keeping up with the literature, and be thankful that you have a world of information at your fingertips. Take an hour a week to be pro-active. Read a journal that you truly enjoy and know that it serves your patient, quells your anxieties, and feeds you inner science nerd, an important part of who we are as physicians. For the rest of the information, be thankful that the Internet is at your finger tips. It is now feasible to search the literature for answers within seconds. And most importantly, stop piling up old journals, especially 'throw-aways'. You will appreciate the lack of clutter.

Resources for understanding the literature:

Daniel Friedland, MD, ABHM author of Evidence-Based Medicine: A Framework for Clinical Practice has created an excellent web site to help you understand and research the realm of evidence based medicine ( http://www.supersmarthealth.com/index.php ).

Some of the recommended resources are:

ACP Journal Club (http://www.acpjc.org/?wni )
Journal Watch (http://www.jwatch.org/ )
InfoPOEMs ( http://infopoems.com/product/features_dailyip.cfm)
And he suggests that providers can also keep up using healthnews services like:

Medscape ( http://www.medscape.com/welcome/news)
MD Consult ( http://www.mdconsult.com/das/stat/body/84647017-2/mnfp?date=week&general=true&mine=true)
Yahoo Health News ( http://health.yahoo.com/news/)
 

Just for fun:

I really love the new CD by Anoushka Shankar and Karsh Kale "Breathing Under Water,". Anoushka is the daughter of Ravi Shankar, the renown classical Indian musician. This new album is a mixture of Sitar music, pop and trance-like sound. Truly beautiful to hear. It features a number of collaborators, including Ravi Shankar, Sting, Norah Jones, Shankar Mahadevan, Sunidhi Chauhan, Vishwa Mohan Bhatt, the Midival Punditz and many more...



Thanks for reading,

Lee Lipsenthal, MD, ABHM