Upcoming Program
Healing the Healer, Rhinebeck, NY, September 7 – 12th, 2008.
22.5 Category One CME/CE
For many years I have been offering a week-long program in Hawaii for
health care practitioners. I am delighted to be offering the same
program in upstate New York at summer's end. Bring a friend, bring
your staff!
This workshop is designed for health-care workers of all backgrounds
and trainings to help cultivate a greater sense of life balance;
spouses and significant others are also encouraged to attend. Click
here for more information and to register.
My mother in-law was right; Dress like a doctor
(This article is dedicated to my mother in-law, who passed away last
month. We will miss you.)
My wife is an internist who has been in practice for many years (I
can't say how many because I don't want to sleep outside tonight). Her
mother, a traditional medical spouse, would often criticize her for
not dressing "professionally". This would always agitate my wife and
make her defensive. Does it really matter how we dress or is it our
'way of being' that matters. The answer is, both our dress and our
attitudes matter and it doesn't hurt if you're good looking too!
In a recent study, four hundred outpatients were shown photos of
physicians with different styles of dress. They were then asked which
doctors they would trust more and be willing to share difficult issues
with. This patient group had a mean age of 52.4 years; 54% were men,
58% were white, 38% were African-American, and 43% had greater than a
high school diploma. The patients clearly favored the professional
attire with white coat (76.3%, P <.0001), followed by surgical scrubs
(10.2%), business dress (8.8%), and casual dress (4.7%). This was true
for men and women, physicians and patients and also correlated with
trust, confidence and the willingness to share their social, sexual,
and psychological problems with the physician who is professionally
dressed (1). These correlates also exist in other areas of health care
such as podiatric medicine (2).
A study of OBGYN physicians showed that these correlates may not hold
true in all circumstance (3). These physicians were randomized to wear
business attire, casual clothing, or scrubs on a weekly basis for
three months. The business attire included a tie (for men) and a
buttoned white coat; the casual outfit excluded jeans but otherwise
was typical relaxed clothing and an optional unbuttoned white coat;
and the scrubs were hospital issue with no white coat. Patient
satisfaction scores were then analyzed.
The physician's style of dress had no impact on the patient's
perception of competency, satisfaction or their impression of the
physician's professionalism. This may be due to a skewed population;
younger women versus the more heterogeneous nature of other studies. A
larger effecter may be that, in this study, physician-patient
relationships developed over time and out weighed the initial
impression of style of dress.
In younger physicians and trainees, choice of clothing may actually
matter more than for mature physicians in all practice environments
(4). Dr. Pamela A. Rowland, a behavioral scientist and director of the
office of professional development at Dartmouth Medical School, who
has studied the impact of physician clothing on patient confidence
says: "Patients don't have your C.V. in front of them, and appearance
is all they have to go by," Dr. Rowland said. "If you don't meet their
expectations, their anxiety level increases."
This is particularly true for the younger generations of physicians.
Culturally, their style of dress is more casual than older generations
of physicians and patients. This can lead to the patient feeling
disrespected. In multiple studies, casual clothing decreased the
patients' confidence in the doctor.
Other preferences which enhance respect include:
Name tags
White coat
Visible stethoscopes
Dress pants, dress shoes, and a shirt and tie were ranked high for men
Makeup, lipstick, and stockings were ranked high for women.
Sandals and clogs, earrings or long hair on male physicians, and blue
jeans received the lowest rankings by respondents with regard to
desirability.
Older patients regarded casual attire more negatively than younger patients did.
Private clinic patients considered casual attire much less desirable
than did patients who had Medicaid insurance.
And, by the way, it doesn't hurt if you look like one of those TV
docs! It turns out that if the patient thinks you are attractive, they
trust you more (6). The McDreamy effect.
And then there is the neck tie, that bacteria laden piece of silk…
So all in all my mother in-law was right—sorry I doubted you.
What to wear today? Effect of doctor's attire on the trust and
confidence of patients. S. Rehman, P. Nietert, D. Cope, A. Kilpatrick,
The American Journal of Medicine, 2005 Nov; Volume 118, Issue 11, pp.
1279-1286.
The Physician's Attire and Its Influence on Patient Confidence; Adam
M. Budny, DPM *, Lee C. Rogers, DPM, Vincent J. Mandracchia, DPM, MS
and Steven Lascher, DVM, MPH, Journal of the American Podiatric
Medical Association, 2006, Volume 96, Number 2, pp.132-138.
Does physician attire influence patient satisfaction in an outpatient
obstetrics and gynecology setting? Richard L. Fischer, MD, Clare E.
Hansen, RN, Robert L. Hunter, MD, J. Jon Veloski, MS, Am J Obstet
Gynecol, 2007, 196:186.
Resident physician attire: Does it make a difference to our patients?
Cha Ann; Hecht Bryan R.; Nelson Karl; Hopkins Michael P; American
Journal of Obstetrics and Gynecology, Volume 190, Issue 5, pp.
1484–1488.
Patients' attitudes regarding physical characteristics of family
practice physicians; Keenum AJ, et al., South Med J, December 2003,
96:1190-4.
The white coat effect: Physician attire and perceived authority,
friendliness, and attractiveness. Brase, G.L. & Richmond, J., Journal
of Applied Social Psychology, 2004, 34(12), 2469-2481.
Lee Lipsenthal, MD, ABIHM
Upcoming Program
Healing the Healer, The Omega Institute, Rhinebeck, NY, September 7 – 12, 2008.
22.5 Category One CME/CE for physicians, nurses and therapists of all backgrounds
Healthcare providers dedicate their lives to serving others, yet often stumble in taking care of themselves. Healing the Healer can help solve this dilemma.
Through discussion, movement, artwork, breathwork, journaling, and meditative techniques, we gain an understanding of the unique stresses faced by healthcare workers and their families, and discover how to diminish their harmful effects.
You will learn to:
Understand the relationship of stress and health
Learn new tools to modify our stress responses
Gain a deeper understanding of transpersonal healing states
Enhance your ability to communicate and love more deeply
Evaluate personality traits that help or hinder your progress, personal growth, and patient care
Adopt action planning tools to create positive changes in your life
This workshop is designed for healthcare workers of all backgrounds and training to help cultivate a greater sense of life balance. Spouses and significant others are also encouraged to attend. For more information and registration, click here.
Meditation
What if there was a product out there that allowed you, in 20 minutes, to prevent emotional outbursts, improve your sleep and blood pressure, and enhance the fun aspects of your life? How much would you pay for it? Meditation is that product. And meditation is free. You don't need equipment, accessories or fancy chairs. You just need a quiet place to sit and 20 minutes a day for meditation to work its magic. Aren't you worth it? Well, all it takes is a little practice.
To some of you, meditation may feel like a foreign concept. It shouldn't. Have you ever sat quietly on a beach, hypnotized by the waves? Walked in the woods, hearing the sound of the trees, and momentarily forgetting about your thoughts? Do you remember playing music or gardening, and just for a moment forgetting who or where you are? Have you ever prayed and felt a sense of connection with something bigger than yourself? These are meditative moments. Moments where it was enough for you to be just you, alone and in peace. In the language of psychology, these are transpersonal moments. In the language of religion, you are connecting with God or spirit. In the language of Hip-Hop, you are chillin.'
Meditation on those you love (5 – 20 minute practice)
There are many forms of meditation available to you. Most people find focusing on emotions of love and caring to be the most pleasing form. It intentionally focuses on the feeling of love, or being in love. It uses this emotion as a focal point to distract your mind from 'busyness.' This is my personal favorite as I am a diehard romantic. We often focus on things that cause anger and frustration; this is the way to inoculate against that habit.
You'll need to generate a list of people, places or things that help you feel loving. It's useful to write down the names of people in your life you appreciate. Include family, friends, mentors and even patients you are grateful for knowing. After doing this, follow the steps below.
First, find a comfortable position, then close your eyes. Take some slow, deep breaths until you feel relaxed and calm. Make the inhale much deeper than usual and the exhale long and slow. This lowers your sympathetic tone.
Picture yourself in a comfortable, peaceful place. What do you see there? Are you sitting or standing? Can you feel the ground beneath your feet or the place where you're sitting? Try feeling the air. What does it feel like? Are there any smells you can identify?
As you relax, begin to see the faces, one by one, of those you had written about. As you see each one before you, remember fondly the times you spent together. Then thank them for the role they have played in your life. Focus on your appreciation and love for that person. In your mind, tell them how you love and appreciate them. Hear what they say back to you, if anything. Then let them go.
If your mind wanders, bring your focus back to this person or someone else you love.
Continue this practice as long as you like while keeping the deep breaths going. You can practice this over and over throughout the day or in one sitting. Vary the time as you see fit. However, you should start with at least 5 minutes each day.
Personally, I end this practice by focusing on my wife. (You will have to find someone else; she's spoken for!) For me, it's a great way to start the day.
By giving yourself this experience, you have altered your physiology as if you had really been in this place with these people. Your catecholamines drop, dopamine goes up, blood pressure decreases and heart rate slows. You also improve cortical function and performance. Not bad for a few minutes of appreciation!
"I shut my eyes in order to see" – Paul Gauguin
Favorite Meditation CDs
Mine, of course – Finding Balance Meditations and Imageries – a guided series of meditations to enhance your learning. Click here.
Jon Kabat-Zinn's series. Visit: http://www.mindfulnesstapes.com/
Marty Rossman, MD's CDs click here.
Just for fun
My favorite CD release of the past month is Jesse Malin's Glitter in the Gutter. If you were to categorize it, think 'alternative', but the range here transcends that label. From the hard rocking "Prisoners of Paradise" (The Replacements are a clear influence here and elsewhere) to the lyrical rock song, "Don't Let Them Take You Down," you will find yourself singing along easily. An awesome summer driving CD! A must hear is the sweet duet with Bruce Springsteen called "Broken Radio" - sweet reminiscence of times past and worth the price of admission. Have a rockin' summer!
Lee Lipsenthal, MD, ABIHM
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
I am delighted to announce the availability of our new
Finding Balance CME On-Line Programs. These on-line
educational models have been created to enhance your
lifestyle and your ability to teach your patients about
healthy life choices. Finding Balance CME On-line is a
series of 12 sessions, on-line, through the Finding
Balance website. Each session is worth one hour of CME
category one credit, with text reading and questions to be
answered. Upon completion of each session, you will be
able to download a one-hour CME certificate of completion.
CME On-line has been developed to provide you with easily
accessible on line content to help you and your patient in
the area of life balance. The sessions can be done in
sequence or separately at your discretion. I hope you
enjoy them!
Session content:
Life Balance and Balance Self Assessment – In this session
the participant will gain greater insight into the concept
of life balance and how it affects performance and
well-being
Physician work satisfaction – This session will review the
contributors to physician work satisfaction.
What Makes a Happy Doc? – This session will outline the
key contributors to physician work satisfaction and
provide tools to enhance satisfaction.
The Physician personality – this session will focus on
areas not covered in depth in the workshop sessions.
Work Addiction – This session will focus on addictive
behaviors and how they affect the family, performance and
our work lives. The core model will be of work addiction
and the 12 step concepts.
Physician health – this session will cover the current
state of physician health and physical well-being.
Diet choices and health – This session will review the
various 'diets' available and contrast them with each
other.
Exercise and health – this session will review the
literature on the benefits of exercise, types of exercise
and scheduling of exercise habits.
Managing stress; meditation - this session will review the
medical literature in the areas of stress management using
meditation.
Managing stress; yoga - this session will review the
medical literature in the areas of stress management using
yoga.
Managing error – This session will review the key areas
regarding medical error and malpractice concerns.
Spirituality, religion and spiritual counseling - This
session will include a review of the literature in the
area of spirituality the role of the physician in
spiritual counseling and on the health.
To get to Finding Balance CME On-Line, go to
FindingBalanceProductions.com and click on CME On-Line
http://www.FindingBalanceProductions.com
Greg Skipper, MD , Medical Director. Alabama Veterinary Wellness Program.
How well do you take care of yourself? Do you have balance in your life? How would you characterize the quality of the relationships in your life? How well do you know your children and families? Do they nurture you? Do you have a gnawing sense of unfulfillment? Do you dream about things you would like to do or changes you would like to make in your life, only to have them scuttled to another time? Sometimes it is easier not to ask these questions in order to avoid looking in the mirror.
I recently ran across the term “thrustration”. Thrustration implies that I consciously push into areas that may be problematic and challenging- sure to move me into new territory. Often the old territory is no more than a well-worn and tiresome rut.
The Alabama Veterinary Wellness Program (AVWP) has some wonderful thrustration producing programs available to help get you past obstacles to change. Learn how enhanced personal well-being can produce positive changes in both professional and personal relationships.
• Recognizing Signs and Symptoms of Stress and Burnout
• Professional Boundaries and Conduct
• Harassment in the Workplace
• Medical Ethics
• Litigation Stress
• The Medical Marriage
• Motivational Interviewing and Stages of Change
The programs are interactive and can be adapted for an individual clinic setting or Association meeting. Special programs may be arranged. For example, a dinner for couples is an excellent venue for the Medical Marriage presentation.
By risking a good long look in the mirror, it is possible to rediscover your choices and the meaningfulness of your personal and professional life. Grappling with what you see and what you want to see in that mirror allows you to eventually reach beyond yourself with tasks to accomplish, animals and people to love, and causes to serve. It makes for a very welcome change. Contact us at 334-954-2594 or by email at staff@avpwp.org. You
can also visit the website at www.avpwp.org.
Gregory E. Skipper, M.D., FASAM
Medical Director – AVWP
What do you do if you or another veterinary professional you know has a problem that could cause impairment? The problem could be burnout, depression, or a problem with alcohol or drugs. These kinds of problems are embarrassing and difficult to face. If impairment occurs then a licensed professional can loose their license and career.
There is usually a desire to do something, to preserve reputations and careers, but because of stigma or indecision we sometimes wait and wait and hope things get better. They often get worse.
Human beings have problems! Veterinary professionals are human beings. Therefore, veterinary professionals have problems. This seems obvious, however, many health professionals resist the idea that they are vulnerable. We have the false sense that having medical knowledge somehow protects us from illness.
Doctors don’t seem to take good care of themselves in general. We know from research that health professionals tend to seek general medical check-ups less often than controls and tend to wait longer before seeking consultation for serious symptoms. We tend to diagnose and treat ourselves and/or obtain treatment from friends. Doctors seem to have difficulty in accepting the role of the patient and fear the potential or real loss of status and authority associated with becoming a patient.
Stress, depression, anxiety, and chemical dependence among physicians are significant problems with a lifetime prevalence of 10-15%. Veterinary professionals are more isolated than other health professionals and if anything have higher levels of stress.
The Alabama Veterinary Professionals Wellness Program, AVPWP, was developed to help. We can offer assistance in several important ways:
1. The Vet Board has agreed to change the annual license renewal question regarding “treatment for alcohol or substance abuse” to allow applicants to say no if they are participating in the Alabama Veterinary Professional Wellness Program, AVPWP. (i.e. They accept participation in AVPWP in lieu of their need to know about and investigate potential impairment?) The last thing you want to do is answer license renewal questions fraudulently. This program allows you to answer honestly and have confidential treatment.
2. We have extensive experience in dealing with problems that can cause impairment. We usually recommend that as a first step a good evaluation be done. We know good resources for evaluation and can provide these referral options to you.
3. We are experienced at doing professional interventions in the least confrontational manner with the best results.
4. The good outcomes that are reported regarding success rates for professionals are contingent upon good follow-up and monitoring. We are setup to do monitoring when appropriate. This protects and advocates for the professional.
There are many other benefits to our program. Please feel free to call and discuss this confidentially and/or anonymously.
Edelstein EL. Physicians as Patients: A Comparative Study of Attitudes of Physicians and Non-Physicians. Psychopathology. 1984; 17:213-216.
Stoudemire A, Rhoads JM. When the Doctor Needs a Doctor: Special Considerations for the Physician-Patient. Annals of Internal Medicine. 1983; 98(Part 1): 654-659.
Anthony JC. Prevalence of substance use among US physicians. JAMA 1992; 11:268(18):2518
By Jerome B. Williams, DVM
In a smoke filled room near the five point’s south area of Birmingham, Alabama, I heard this icon of spiritual knowledge and wisdom stated with clarity and confidence; “serenity is better than sex.” The simple but profound statement did not go unchallenged by me or other meeting members. My interest was piqued at his analogy; so much so that during one of our subsequent early A.M. coffee meetings, I questioned him further. I needed to understand his view of serenity.
He began to recount those years of misery and pain. The same stories that many of us with obsessive compulsive diseases such as drug addiction and alcoholism understand, Those all-too-familiar feelings : Terror, Bewilderment, Frustration and Despair – the four hideous horsemen of the apocalypse talked about by recovering alcoholics,” rang hauntingly familiar. Many painful memories began to resurface and I remembered how it once was.
When in the midst of this inner spiritual battle there is no way out. One can yearn for serenity, attempt to pray for it, bargain away anything for it-- but it does not come. Such desperation can give the impression that life has no true value; absolutely no meaning. One despairing conclusion could be that life is merely passing along, leaving nothing but shattered hopes and broken dreams. Such appearances of doom lead to a hopeless state of mind, body, and spirit. Sometimes the mental and emotional pain is so severe all options for relief are considered, including suicide. During these times, serenity or peace of mind seem all but lost forever!
Once introduced to the hope of recovery I repeated the words of the serenity prayer but peace still would not come and those early times were emotional and perplexing.
"God grant me the serenity to accept the things that I cannot
change the courage to change things that I can and
the wisdom to know the difference."
Strangely enough, I eventually discovered through working with others who had found a way out of these seemingly hopeless dilemmas, there was hope for me. I was ultimately granted a new lease on life. It was at that point that I could comprehend the word “serenity” and to the core of my being began feeling peaceful at last. It was also at that point that I knew peace and subsequently no longer felt pressure to bear life’s burdens. My burdens were given to a power greater than myself, God of the universe.
Over the years I have encountered a number of individuals who were at that critical jumping off point. These individuals had begun to spiral down an abysmal descent of hopelessness due to a variety of life challenges. These challenges often included; alcoholism, drug addiction, illness, depression, anxiety, fear, gambling, sex, food, divorce and loss. During these times of the “dark night of the soul,” there is an emptiness, a deep knowing that something vital is missing.
Most of us who’ve faced this abyss have tried many things to get help including support from family, friends, self-help meetings, religion and will power. All fail for me until I asked for help from the individuals who’d recovered from that same seemingly hopeless state of mind. These individuals had the tools and knew the steps required to effect a change.
By learning to trust and receive help from my wounded peers who understand the nature of our affliction, hope was somehow restored and a miracle seemed to happen. I slowly grew strength to stand up with dignity, and entered a world of true spiritual freedom. Trust is not easy. In fact, it can be scary, but it is absolutely essential to cultivate it. The key for me was to take things step by step; even when the steps resembled a baby’s beginning stride. The most important thing for me was to remember to persevere, regardless of the pace.
Now I know that knowledgeable, trustworthy individuals and professionals were waiting to help all along when I was ready to ask for help. It was extremely difficult for me to acknowledge that I needed help. Besides, who wants to admit that their way has failed? Especially a licensed, medical professional! Once I finally did, however, there were more than enough hands and arms to support me through the process of reclaiming my sanity.
Today, I’m writing to let others know that there are many more hands and arms waiting to embrace them, if they need support; to help lift them out of their misery and guide them toward a place of peace and serenity. While that might seem unreal and practically impossible at the moment, it really can and is being done!
If you, a loved one, or a fellow colleague needs help, please don’t hesitate to reach out and and ask for help. Help is ready, waiting and eager to begin the healing process with you.
If you are able to help others, we implore you to remember our colleagues and extend a hand to them. We are a profession of individuals who are very prideful, sometimes to our detriment. Please do not allow pride or perceived weakness to hinder you in reaching out to give or receive help.
The icon of spiritual wisdom and knowledge who spoke so eloquently to my soul that night, “Happy Jack,” was an inspirational figure in my personal battle with drug addiction and alcoholism and my guide through 15 years of pain and growth.
Through his illumined consciousness, Jack, and many like him, helped countless others go on to learn about living a life free from the captivity of one’s own ego; a true freedom from the bondage of selfishness. It is from those lessons that our gratitude keeps us going strong, and our desire to serve allows us to continue the message of true peace and serenity.
After years of embracing the path to serenity (and one who also happens to really enjoy sex and count it as one of the greatest pleasures in life), I must fully agree with my late sponsor and friend, Jack ….
"Serenity is better than sex!"
Note: Dr. Williams has been a practicing veterinarian for 38 years and is currently serving as chairman of the Alabama Veterinary Professionals Wellness Committee. He is actively involved in recovery and wellness at all levels, and is available to speak to community and recovery groups upon request. He can be reached at Red Mountain animal clinic, 2148 Greensprings Highway, Birmingham, Alabama 35205, 205-326-8080, website redmountainanimalclinic.com, and email jbw12@prodigy.net
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