Trust & Lies: The Predicament of Modern Medicine

Trust is absolutely pivotal in the practice of medicine. Patients need to trust their physicians. Physicians need to trust other members of the medical community. The medical community needs to trust the medical literature and evidence-based guidelines. But what if much of day-to-day medicine is actually rooted in subtle lies, bias, faulty perceptions and misconceptions?

The Lies We Tell – Social Bias, Myths and Blindspots in Medicine is a brilliantly written piece by Dr. Charles Odonkor and a worthy read for any aspiring medical student or young physician. It is a call to first, be honest with yourself. It will be the next generation of physicians’ unique challenge to “reconcile the disharmony between stated ideals vs. the realities, which often arise in the imperfect science and art of medicine.

Part 2 to the above series, here.

More to come on the topic of trust in medicine in the coming weeks.

 

Do Androids Dream of “He” Docs?

In a courageous JAMA article from this month, “Putting the “She” in Doctor,” Dr. Ersilia M. DeFilippis tells the story of Margaret Ann Bulkley (aka, James Barry) a 19th century Irish military surgeon who dressed as a man in order to pursue a career in surgery. As a 21st century physician, Dr. DeFilippis laments that it would probably be easier on female doctors if they continued to dress as men.

““For the women in the room: raise your hand if you have ever been called a nurse.” I was in a residency noon conference on gender bias in medicine. Everyone raised their hands, including the newest interns who had started a few months earlier. When the speaker asked the men in the room, no hands went up.”

Sexual assault, harassment and sexism toward women in medicine is rampant, underreported and directly affects patient care and outcomes. If you’re wondering why this is read Dear ACGME: Primum non nocere.

“Sexual assault and harassment has been shown in all levels of academic medicine from attending physicians to resident physicians to medical students, but only 20% of these behaviors are reported.” 

Ideas for how to address this dark secret in medicine, including a Response to Dr. DeFilippis’s piece, are beginning to surface. If you have any ideas of your own, please comment.

 

Female Physicians Speaking Up

Elizabeth Raskin, fourth from left, poses for a portrait with colleagues Alicia Teferi, Elisa Bianchi, Valentina Bonev, Maggie Legan, Sharon Lum, Allison Davila, Ann Lin, Kristine Bonnick and Eugenia Kwon, left to right, at the Loma Linda University Medical Center on January, 30, 2018, in Loma Linda, Calif. Raskin says workplace gender equality is a big emphasis at Loma Linda University Medical Center; she hopes other hospitals, health care centers, and institutions will follow suit. Dania Maxwell / for NBC News

First, SELF

“Physicians, caregivers, administrators and others who are responsible for caring for others often find themselves at risk of stress and burnout. Stress impacts people differently; female physicians have a suicide rate up to four times greater than the national average. Persons who identify with minority groups also face minority stress; African Americans suffer from higher rates of cancer and diabetes than other groups. LGBT persons suffer from higher rates of depression and addiction. As we begin 2018 it’s more important than ever for all of us to continue to identify stress and respond in healthy ways.” – R. Scott Boots, MPA, The Health Cares Exchange Initiative, Inc. 

The Health Cares Exchange Initiative, Inc. (HCEI.org) was founded in Boston nearly three decades ago in response to caregiver stress. HCEI’s seminar “Celebrating Ourselves: Beating Burnout” has been presented to thousands of caretakers around the world. Most people hide stress from others and will rarely ask for help. But when caring people care for themselves first, they care for others better. Please visit HCEI.org to join efforts to support medical students, residents, physicians and caretakers in your community.

Photos courtesy of the links.

The Neuroanatomy of Social Stereotyping

Today we recall, celebrate and reflect on the birth and life of the great civil rights leader,

Martin Luther King, Jr. 

Social stereotypes have a neuroanatomical basis, and they can cause as much – or more – suffering than cancer, hunger or physical trauma. The images below represent the biological roots of racism, bigotry, genocide and oppression. By attempting to understand our own brains and biases, we can begin to bridge gaps of social division, nurture compassion for ourselves and others, and do our own little part to promote peace on this planet.

The ventral medial prefrontal cortex (vmPFC) (a) is activated

when stereotyping individuals via “person judgements”.

The amygdala (b) is also activated when stereotyping,

as well as the middle temporal gyrus (c) and the supramarginal gyrus (d).

“Acquired during early childhood and reinforced throughout adult life, stereotypes shape thought and action in innumerable ways. In a world of daunting interpersonal complexity, the primary benefit of stereotyping is that it offers apparent insights into the personalities and deeds of others without the cumbersome necessity of getting to know them. For example, whereas women are thought to be nurturing and to be found cooking and gossiping, emotionally repressed men are believed to enjoy repairing cars and guzzling beer. While clearly simplifying the process of person understanding, stereotypical thinking is not without its problems. Through indiscriminate application, stereotyping promotes judgmental inaccuracy, societal inequality, and intergroup conflict.

fMRI images and quote from Quadflieg et al. (2008). Exploring Social Stereotypes. J Cognitive Neuroscience, 21:8, 1560-1570

May we all put forth a greater effort to understand ourselves and each other.

Happy MLK Day!

 

Recognizing Metaphor

“Recognizing metaphor in life is the highest form of genius.” -David Charron
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When we see connections between seemingly unrelated things, poetry in struggle, dendrites in leaves, we are literally forging new paths of possibility in our minds and in the world around us. New synapses are formed and reinforced. Novel neural networks are ignited. And the medial frontal lobe launches us forward on a path of meaning, making our marks.
The piece above, resembling a neuronal synapse in wood, is by artist Charles Pifer. It is the result of an experimental artistic process combining various natural woods, electrolytic solutions and electric currents.

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An excerpt of the process from the artist’s own words:
“I throw the switch with a 5 foot section of PVC pipe to prevent being anywhere near the device while it is on. Immediately the electricity begins to burn it’s way through the porous wood soaked in the electrolytic solution.”

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“The electricity is seeking the path of least resistance between the clips, and the neuronal forms are a byproduct of this action. Once the two sides meet, the electricity begins to arc through the air. I suspect it is using the wood smoke as a medium for travel as the device cannot arc this far normally. I shut off the machine before the piece catches fire.”

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“I take the burned wood and brush out the char. I paint the entire piece and sand down the surface until only the paint in the electrically annihilated forms remains.”

Beautiful! Thank you, Charles!

Charles Pifer is a local Architect and Founder of Blade and Branch, a small business based in Tucson, Arizona, which is focused on and harnessing natural phenomenon into beautiful art pieces.

[Photo credit: Charles Pifer, December 2017]

 

The Power of Gratitude

“The most important and most significant good quality in our human life is gratitude. It is the only quality that will help everyone solve his problems and also run the fastest.” -Sri Chinmoy, The Jewels of Happiness

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Gratitude can bring more meaning and resilience to our work. 

7 Scientifically Proven Benefits of Gratitude

The Neuroscience of Giving Thanks 

 

 

[Photo credit: Leif Hass, Greater Good Science Center at UC Berkeley]

 

Powerful Retorts

Minority in your chosen profession or not, we all sometimes find ourselves in sticky situations at work. Here are some powerful retorts for your professional armamentarium from 7 Tricky Work Situations by Alicia Bassuk published in the Harvard Business Review:

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Design by Sasha Retana, MD. Photo courtesy of Abacus Group.

See full article for descriptions of situations.

Situation #1: Someone takes credit for your idea.

What you should say:

“Thanks for spotlighting my point.”

 

Situation #2: You’re asked to stay late when you’re about to leave the office for a personal obligation.

What you should say:

“Excuse me, I have another commitment.”

 

Situation #3: In a pivotal situation, a trusted colleague snaps at you.

What you should say:

“This isn’t about what you do for me. It is about what you did to me.”

 

Situation #4: You have to say “no.”

What you should say:

“This is a good launching point.”

 

Situation #5: You have to give negative or awkward feedback to someone you’re close with.

What you should say:

“I’m here to be for you what someone once was for me.”

 

Situation #6: You need to push back on a decision you believe is wrong.

What you should say:

“This is my preference.”

 

Situation #7: You need to escalate a serious issue.

What you should say:

“Your response gives me cause to take this further.”

 

 

 

 

#Metoo in Medicine

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by Anonymous, MD (for fear of retaliation)

I recently conducted an informal survey among fellow physician moms on Facebook’s Physician Moms Group page. I asked my female physicians friends to talk about their experiences with sexism, sexual harassment and sexual assault in medical school, residency and post-residency. Medicine in the United States has historically been a field dominated by white males. It’s only been in the last 40 years that women have been permitted to don the title of “Doctor” on a consistent basis. Finally, in 2017, U.S. medical schools are admitting a near equal proportion of male and female medical students. Unfortunately, the equal treatment in the field stops there. Female medical students are disproportionately encouraged to go into “softer” fields of medicine – internal medicine, psychiatry, pediatrics – and leave surgical specialties to the men. Indeed, in our present day, women make up only 10-30% of surgical residents in this country. The women that do enter these male-dominated subspecialties are often subject to persistent yet subtle discrimination by their male counterparts in what often feels like a concerted effort (be it conscious or subconscious) to push them out of the field along the course of their training and careers (see excellent book by Dr. Frances Conley, “Walking Out on the Boys”). As medicine is also an inherently hierarchical profession, it proves very easy for male colleagues to “get away” with daily sexist comments, harassment, and in some cases sexual assault. Complain, and lose your promotion. Raise your voice, and be fired. The boys will be sure to have each others’ backs. Fears of retaliation, including the incineration of hard-earned careers, paralyze the female practitioner from taking action.

Of the numerous stories shared in my survey, only two doctors ever reported their stories of sexual harassment and assault to authorities. In one case, the young doctor’s residency program director fully supported her through the traumatic process and vowed that sexual discrimination, harassment and assault would not be tolerated in his program.

The other doctor was not so lucky. Her case ultimately ended in litigation, and she had to fight tooth-and-nail to preserve her career and reputation in an environment in which her program director and other physician colleagues were tearing her to pieces – trying to force her out of medicine altogether.

Not surprisingly, in this traditionally white male field where all power seems to reside in the hands of very few at the top, only one physician of those surveyed had a suggestion as to what to do about the persistent problem of sexual discrimination, harassment and assault among female medical students, residents and physicians: “Work on holding the Accreditation Council for Graduate Medical Education (ACGME) accountable,” and “We need to identify a few leaders amongst female residency program directors to put forth resolutions in the Program Director Associations.”

Of the 145 neurosurgery residency program directors, only one is a woman.

Learning Optimism

In the classic positive psychology text, Learned Optimism, Martin Seligman, PhD discusses the importance of optimism in surviving and thriving through setbacks and failures. It is optimism that distinguishes the most successful from the rest.

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Anatomically, optimism in the brain has been localized to the rostral anterior cingulate cortex and amygdala – two areas that can be strengthened with practice. As a minority in one’s chosen field, the stronger you can make these areas of your brain, the more you can persist through difficulties and discrimination with equanimity and ease.

“Nothing in this world can take the place of persistence. Talent will not: nothing is more common than unsuccessful men with talent. Genius will not; unrewarded genius is almost a proverb. Education will not: the world is full of educated derelicts. Persistence and determination alone are omnipotent.” -Calvin Coolidge