Tag: physician

Reading of the Week: CBT for Depression – the Latest Evidence; Also, Digital Mental Health (World Psych) and Dr. Castro-Frenzel on Her Cancer (JAMA)

January 26, 2023 /

From the Editor

Cognitive behavioural therapy is widely used for the treatment of depression – but the last significant meta-analysis was published a decade ago. What’s the latest evidence? 

In the first selection, Pim Cuijpers (of the Vrije Universiteit Amsterdam) and his co-authors try to answer this question with a new meta-analysis including more than 400 randomized trials with almost 53 000 patients (yes, you read that correctly). In this World Psychiatry paper, they compare the therapy with controls, other therapies, and medications. They write: “We can conclude that CBT is effective in the treatment of depression with a moderate to large effect size, and that its effect is still significant up to 12 months.” We consider the paper and its clinical implications.

Beck: the father of CBT

In the second selection, Dr. John Torous (of Harvard University) and his co-authors look at digital mental health. Despite widespread use of smartphones – perhaps 80% of the world’s population now has access to one – “digital mental health is not transforming care.” In this Editorial for World Psychiatry, they wonder why. They also point a way forward: “Developing a new generation of digital mental health tools/services to support more accessible, effective and equitable care is the true innovation ready to be stoked today by each person who becomes empowered to connect, set up, engage, start/stop, and demand more from mental health technology.”

Finally, in the third selection, Dr. Karla Castro-Frenzel (of the University of Central Florida) writes about a patient with advanced lung cancer. As it turns out, she’s that patient. In this personal essay published in JAMA, she writes about being a doctor and a patient. “My ultimate hope… is that we can create space for illness as well as wellness. In helping our colleagues feel safe and supported when they become patients, we rehumanize our environments and our very selves.”

DG

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Reading of the Week: Psychiatrists & Patient Suicide – the New CJP Paper; Brain Wellness Spas (JAMA Psych) and Dr. Heidari on Her Mantra (NEJM)

September 29, 2022 /

From the Editor

It’s the call we dread, perhaps from a relative or the family doctor. The news catches us by surprise: the patient has died and suicide is suspected.

In the first selection from The Canadian Journal of Psychiatry, Dr. Zainab Furqan (of the University of Toronto) and her co-authors consider psychiatrists’ experiences with patients who die by suicide. In this qualitative analysis drawing on 17 interviews, they explore the emotional response. They conclude: “patient suicide is often associated with grief, shock, anxiety and guilt; emotions which are mediated by physician, patient, relational and institutional factors and have important ramifications on psychiatrists’ well-being and clinical practice.” We consider the paper and its implications.

In this week’s second selection, Anna Wexler and Dominic Sisti (both of the University of Pennsylvania) write about the potential and problems of off-label use for psychedelic drugs in light of likely FDA approval. In a JAMA PsychiatryViewpoint, they note: “With high public enthusiasm, extremely bullish investors, and hundreds of newly established brain wellness clinics, all the pieces are now in place for expansive off-label promotion and use of psychedelics to quickly mushroom beyond what is safe.”

Finally, in the third selection from The New England Journal of Medicine, Dr. Shireen N. Heidari (of Stanford University) notes the incredible challenges of working during the pandemic – and the psychological toll. She describes her decision to seek care and her own recovery: “A year after making the decision to talk to my family and my doctor, I know that advocating for my own mental health was the best decision I could have made.”

DG

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Reading of the Week: Cancer & Suicide – the New Nature Medicine Paper; Also, Dr. Natasha Steele on Her Cancer (NEJM)

April 7, 2022 /

From the Editor

The big diagnosis. Even years after the fact and even in cases of good outcomes, so many still remember the exact moment when they were told that they had cancer. A patient once recalled with great detail the floor tiles in his doctor’s office (he couldn’t bear looking at his spouse or his doctor). He also remembered feeling so overwhelmed that suicide seemed like an option.

But what is the risk of suicide? In the first selection, Michael Heinrich (of the University of Regensburg) and his co-authors seek to answer that question, drawing on an impressive number of studies including more than 22 million patients. In a new paper for Nature Medicine, they report on a systematic review and meta-analysis; they found that “patients with cancer have an almost twofold increased risk of dying by suicide compared with the general population.” They write: “Despite immense progress in cancer therapy and prognosis in the past decades, suicide remains an important cause of death in patients with cancer.” We consider the paper and its clinical implications.

In the second selection, Dr. Natasha Z. Rabinowitz Steele (of Stanford University) considers her experiences in a New England Journal of Medicine paper. She writes about her cancer diagnosis and treatment, and the impact on her clinical work. She concludes: “Though all of our journeys will have beginnings and endings, our lives are what we choose to do with the precious, unpredictable, terrifying, and beautiful moments in between.”

DG


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Reading of the Week: Physician, Heal Thyself – the New JAMA Paper on Visits for Mental Health; Also, the History of Physician Wellness (NEJM)

February 17, 2022 /

From the Editor

The days have been long. As we enter the third year of the pandemic, many are feeling it. 

What has the impact been on the mental health of us physicians? We have anecdotal evidence, but data has been lacking. In the first selection, we consider a new paper by Dr. Daniel T. Myran (of the University of Ottawa) and his co-authors. Drawing on data from 34,000 Ontario doctors, the authors considered MD visits for mental health and substance (in other words, doctors visiting their doctors), finding that such appointments were up 27% during the first year of the COVID-19 pandemic. “These findings may signal that the mental health of physicians has been negatively affected by the pandemic.” We look at the paper and the invited commentary that accompanies it.

In the second selection, Agnes Arnold-Forster (of the London School of Hygiene and Tropical Medicine) and her co-authors consider the evolving understanding of physician health by looking to history. They argue that three concepts – medical exceptionalism, medicalization, and an emphasis on individual responsibility – have harmed physicians, creating “excessive commitment and complete personal sacrifice.” They suggest an alternative. “By attending to the lessons of the past, we can envision a better future for patients and their physicians.”

DG


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