The PillboxDear Readers,
The MSPress Blog is on hiatus from October 10, 2018 to February 10, 2019.
If you are interested in contributing to The MSPress Blog or are interested in joining our team, please email journal@themspress.org to request an application.
Thank you!
Sincerely,
The MSPress Team
Wallflower by Janie Cao Edited by Mary Abramczuk Two Novembers ago, I decided to try painting again. At that point, I had been studying medicine for a little over 2 years. After browsing YouTube’s collection of painting tutorials, I found one that seemed realistic for me. It was a still life of roses. There's a common saying-- "stop and smell the roses." Have you heard of it? It suggests a world that is riddled with roses. I wish that was the world we lived in. In those years being surrounded by scientific medicine, I think I was learning this: sometimes by the time you arrive, the roses have all been picked. Then it's up to you to create beauty, again, from the ashes.
PC: TonalLuminosity
Hello everyone!
As you have noticed, there wasn’t a blog post scheduled for today, so I wanted to take this opportunity to get your feedback on an idea 🙂
Have y’all* heard of PostSecret? I was wondering what it’d be like if we started a project where we asked people in medicine to write anonymous letters (max 250 words) to their own doctors/healthcare team?
That’s all I’ve got for now. Would love to hear your thoughts! Please comment below or send them to Janie at hongjingcao@gmail.com (would be helpful if you included “MSPress” in subject line).
Thank you! 🙂
Usually a bit excited about something,
Janie Cao, Blog Associate Editor
P.S. If you ever have blog post submission ideas, please send them directly to me at hongjingcao@gmail.com (with “MSPress” in subject please)
P.S.S. I’m working on “Out There: Part 2”- hopefully will be ready for next Thurs!
*I live in Texas; No, I don’t ride a horse to school.
PC: Grant Hutchinson
Out There: Part 1 By Janie Cao Edited by Mary Abramczuk
I met Thanos Rossopoulos through a community service leadership program. As with almost everyone I’ve met, I stereotyped him at first glance (subconsciously, of course). I thought that he was going to be like most other first-year medical students I’d met before—smart, hardworking, and…pretty fresh from college. And guess what? I was only mostly right. The first time I heard him share his story, we were at a group dinner. I was sitting too far away to hear everything but at the perfect distance to want more. He said something about ‘7 gap years,’ the oil and gas industry, and living in India. That was enough to nag at my curiosity, so I unashamedly asked for an encore. He graciously obliged. Like many people in their early twenties, Thanos wasn’t quite sure what he wanted to do with his life when college graduation arrived too soon. He remembered that at the time, he’d just wanted to do something exciting, something risky, something “radical.” So when they offered him an engineering job that would put him in the oil rigs of India for one and a half years, he said yes. There, for the first time in his life, Thanos stared into the glare of deprivation. Not really what he wanted, but perhaps what he really needed. Growing up in Orange County, California, he had been raised in a privileged “bubble,” as he called his sheltered childhood. But he didn’t know how sheltered he was until he stepped foot into India, where he saw mansions and slums coexisting side by side, all in broad daylight. “It took India to force me to face inequality,” Thanos reflected, “and it didn’t sit with me well.” What he made sound like ‘just a slightly uncomfortable feeling’ was in fact the beginning of a tenacious zeal to alleviate human suffering. He was a tad modest. The impact of those years in India manifested powerfully after he returned home. Whereas in the past, he did not even know to look for inequality, now that was all he could see around him. So, what did Thanos do next? What would you have done? To be continued… -------------------------------------- Photo Caption: "...Taking a stroll in the morning before my shift on the oil rig. If you look closely out in the distance you see the top part of the oil rig I worked on behind the trees. This was from a small village called Radhapur in the state of West Bengal. Very beautiful place." -Thanos Rossopoulos
Hello Clinical Laboratory, my old friend,
I’ve come to take my blood test with you again. Because my specialist wants the latest update, so I visit you every 3 months. My appointment was 48 minutes ago, and there are 16 people who arrived earlier than me, still waiting. As the clock ticks, I can hear everything but the sound of silence. Of course you are not alone, Clinical Lab; my other doctors made me wait for them as well. On average, Americans wait 19 minutes and 16 seconds to see a physician, according to Vitals’ Wait Time Report [1]. But the report forgot to add the wait time for check-in at registration and in the examination room. The funny thing about waiting in a clinical laboratory is that a majority of the patients have been fasting before a blood test. So now your patients are not just becoming impatient, but also hungry (or as young people like to call it, “hangry”) as we enter lunchtime.
You offered some reading material to help us pass the time. Many clinics present entertainments like magazines and television to improve the waiting experience [2]. I once visited a fancy clinic that provided an espresso machine for parents and a touchscreen-wall video game for their children. But I have to tell you: I have watched this Judge Judy episode four times in other clinics’ waiting rooms, and I have no desire to touch this well-thumbed Cosmopolitan magazine. Thank you, but, no thanks.
You might wonder why I care about waiting so much. Let me be honest with you: like most of your patients, I compare the waiting time with the time actually spent with the doctor [3]. As patients, if we spend 45 minutes waiting but only get 5 minutes of the doctor’s time, we won’t feel all that waiting was worth it. Certainly, I understand that a vast amount of effort was made behind the scenes. Like the story of Picasso and the bold woman, most people don’t understand that a seemingly effortless one-stroke drawing actually took a lifetime of practice to achieve [4]. I imagine that Dan Ariely and Jeff Kreisler would happily back me up in their book Dollars and Sense: “Assessing the level of effort that went into anything is a common shortcut we use to assess the fairness of the price we’re asked to pay” (in our case, we pay with time). To solve the problem of customers being reluctant to pay for “invisible effort,” Dan offered the solution of providing transparency [5]. For example, shipping tracking shows all the transactions in each location, and an open-kitchen restaurant shows its staff busy fulfilling food orders. Needless to say, due to medical confidentiality, you can’t have an “open clinic” that shows the staff taking blood pressures or running tests to everyone in the waiting room. But perhaps you could still give us some indication of the “behind the scenes work.” Tell me that you were reading my medical history, that you were double-checking my results, or that you were researching the latest cure. It would make me feel much better to know that you were doing all the “ground work” while I was waiting for you. And I will pretend that I didn’t see you eating bonbons and doing crossword puzzles as I walked past the doctors’ lounge.
And now, I would like to end this letter with a quote from Oscar Wilde’s “The Importance of Being Earnest”:
If you are not too long, I will wait here for you all my life.
Yours truly,
Yi-Lin
References:
———
Author: Yi-Lin Cheng (website)
Editor: Mary Abramczuk
Image credit: Abraham Solomon, “Waiting for the Verdict” (England. 1859), The J. Paul Getty Museum, via Getty.edu
Smiling Rust By Janie Cao Edited by Mary Abramczuk
My grandpa used to be a particular quirky smile. He was once a certain amused sigh. But nowadays, at visits I pay He’s a bag of dust— hidden behind marble and rust. On those days, I am truly glad That I believe in more than what passes the eye. ----------------------------- Photo credit:lavagirl66
Last week I had my semiannual dentist appointment. Right after I stepped out the door, I received an email: Dental Office – Patient Satisfaction Survey. Hi, thank you for visiting the dental office. Please take a minute to complete the survey…. Was it a déjà vu? Didn’t I just fill this out recently? Oh wait no. That was for the hygienist? Or was it for that new periodontist? Maybe it was my other specialists?
So besides rating my favorite restaurants and shops on Yelp and Google, now my clinics and insurance companies also want to know how I would rate my doctors– how splendid!
To my surprise, when I clicked the link, the questions were trickier than I expected. According to the email title, it seemed like the survey was about my dentist, but 75% of the questions were about the clinic itself: Waiting time in reception area, appointment phone call answering friendliness, waiting room neatness, office decoration….(Wait…my dentist is responsible for decoration? Great, let’s talk about changing the interior lighting and repainting the wall at the next appointment). As I was filling out the questionnaires, my head started to spin with my own questions: It was a normal checkup appointment, will “fair” be good enough? But I remembered I had given the hygienist an “excellent,” and honestly I couldn’t tell which one was better…oh boy! How are they going to use my answers? Who will be reading my survey responses? Who will be affected by my answers?
To me, it’s difficult to judge the doctors’ performance fairly. I can measure a finance manager by his portfolio performance, a designer by how many designs have been ordered, and a lawyer by how many lawsuits she has won. But judging a doctor is more like judging a piece of artwork: there’s a lot of subjectivity. How do I know Dr. ABC is better than Dr. XYZ? By my test result? Or by the number of medications they prescribe? Like with my dental visit, I couldn’t really tell the difference between that cleaning from the previous ones. Interestingly, some physician groups use patient satisfaction surveys to allocate bonuses [1]. That would make the weight of responsibility seem heavier; I would hate to find out that my dentist lost his Christmas bonus because of my thoughtless answers.
Needless to say, it’s difficult for management to evaluate every department and employee in a large organization. I truly hope that upper management does not blindly rely on this “big data” to determine a doctor’s career path. I would very much like my doctor to focus on my health, instead of for him or her to be driven by monetary incentives and to act as a salesperson. If the survey data is used for allocating the budget, perhaps the survey needs to be transparent about how the clinic is going to use the result: “This survey is for quality training purposes only” or “this survey is for determining the best doctor of the month and who gets the nearest parking spot.” I suspect that knowing the purpose of the survey helps the respondent think twice before jotting down comments or complaints. It might motivate patients to actually finish the survey (I would very much like to meet the saintly soul who is able to finish 30 ambiguous questions without losing their temper). Also, I would like to suggest that since we are giving patients such power, perhaps we can give some power to the physicians too and allow them to rate their patients (like how Airbnb and Uber lets hosts/drivers grade their guests/riders).
Surveys and ratings can be important sources of information. If I need to find a new doctor or specialist, the first thing I do is go on Yelp and sort the list by how many stars they have. Some industries routinely rely on survey systems to improve their customers’ experiences [2].
I understand that the idea behind patient satisfaction surveys is to encourage more communication. But at the end of the day, I believe that the doctor and the patient should have a strong mutual trust that enables them to communicate and give feedback freely and respectfully, without needing to rely on 30 ambiguous survey questions.
Reference:
Edited by Shaun Webb
Photo credit: Steve Harris
Special thanks to Blog Associate Editor, Janie Cao, for some last-minute content revisions
To learn more about the author, please visit her website here
The Dying Man
Written by Janie Cao
Edited by Mary Abramczuk
A few years ago, I spent half my day with a dying man. I remember these things about him: his name, his past profession, and that he was dying alone. I never saw his résumé, the size of his house, or how much money was left in his bank account. I was not curious to know, either. But I bet they seemed significant once upon a time, at a dinner party, maybe. He worked as an engineer. On that day—the day he died—no one who had cared about those things was there. I was a stranger, yet I saw his last breaths. It was a curious day. This world teaches us to do many things. To set goals (S.M.A.R.T ones, in fact) and to meet them. To maximize profit and minimize loss, and to use other people, to our advantage. We learn to build storage houses and efficiently fill them with glorified trash; to talk like we matter, and live like it, too. Someday, we will all be that dying man. Not fully here, and not quite there; mere wisps of breath. When that day comes, will this world be at your bedside? Sometimes, I wonder. ----- Dedicated to a friend: May you find what you are searching for. Photo credit: Jörg Lange
When a friend recently asked me to join them for a class at Inscape, a New York-based meditation studio that New York Magazine described as the “SoulCycle of meditation”, I was skeptical. On the one hand, I usually meditate at home for free, so paying almost $30 for a meditation class seemed a bit silly. On the other hand, my meditation practice had dropped off considerably since the beginning of the year. Maybe an expensive luxury meditation class was just what I needed to get me back into my regular practice. Stepping off bustling 21st Street into the clean modern space, I heard the sounds of, well…nothing. It was incredibly quiet. Before getting to the actual meditation studios, I had to pass through Inscape’s retail space. The minimalistic shelves hold a variety of supplements, tinctures, and powders that include unique ingredients like Reishi medicinal mushrooms and cannabidiol extract. Many contain adaptogens, herbal compounds that purport to increase one’s resistance to stress, though their efficacy has never been quantitatively proven.[1] These products’ promises run the gamut from shiny hair and stress relief to aura cleansing. I may be a super-skeptic, but even I am not immune to the lures of top-notch marketing. With great consideration, I purchased one of the many magical powders for sale labeled as ‘edible intelligence.’
Since wellness has become trendy, a considerable space in the retail market has opened for associated products dedicated to helping people live their best lives. As Amy Larocca pointed out in her June 2017 article The Wellness Epidemic, “[In the wellness world] a loaf of bread may be considered toxic, but a willingness to plunge into the largely unregulated world of vitamins and supplements is a given.” Even a recent episode of Modern Family poked fun at the wellness trend when Haley Dunphy applied for an ultra-competitive job with fictional wellness guru Nicole Rosemary Page. During her interview at Page’s Nerp company headquarters, Page laments, “People say that Nerp is nothing more than a con-job, a cash grab vanity project from a kooky actress. I want to turn Nerp into the next Disney-Facebook-Tesla-Botox. It’s a world changer.” Though Page is a fictional character, I can’t help but wonder whether the character was inspired by the very real Amanda Chantal Bacon, the founder of Moon Juice, which bills itself as an adaptogenic beauty and wellness brand. Bacon’s Moon Dusts retail for $38 a jar and come in varieties such as Spirit, Beauty, and Dream.
The bottom line is that a sense of well-being needn’t come at the price of thirty-plus dollars an ounce. In fairness to those who choose to spend lavishly, I believe that plunking down a chunk of cash might create an intention to use and derive value from a product, thus positively influencing one’s perception of how well the product works. Rest assured, however, that living with intention and gratitude can be just as easily accomplished without spending any money at all. Carving out time in the day to create a small ritual for yourself can be as simple as spending a few minutes in the morning listening to jazz as you drink your first cup of coffee or allowing yourself to become immersed in a good book before drifting off to sleep. These simple acts allow us to bestow kindness upon ourselves that is especially important in our stressful and busy lives as medical students. My suspicion is that by performing such rituals with intention, we derive much of the same benefit whether our mug is filled with the trendy mushroom coffee or just plain old Folgers.
I’m always thinking about ways I can improve my own well-being, but as graduation approaches I also find myself thinking about how these practices might help my patients as well. One of my fundamental goals as a future psychiatrist will be to help my patients see the value in themselves and in their own lives. I predict that for many of my patients, achieving this goal will depend perhaps on medications but also on the deployment of simple wellness tactics such as I described. I’m not going to lie…I’m still intrigued by many of the wellness products that can be found in places like Inscape, Whole Foods, and the Vitamin Shoppe, especially when I think about the potential benefits they might have for my future patients. I figure that if these products do even half of what they promise to, some of them might even be worth the money. So what happened when I added a sachet of intelligence powder to my usual morning smoothies? Pretty much nothing. At one point, I got excited when I began to feel my fingers getting tingly. Then I realized I had been leaning on my ulnar nerve. Not so brainy after all.
[1] Reflection Paper on the Adaptogenic Concept, Committee on Herbal Medicine Products of the European Medicines Agency, May 2008.
Photo credit: Open Grid Scheduler / Grid Engine