Tag: physicians

Reading of the Week: Employee Well-being & Corporate Strategies – the new Industrial Relations Paper; Also, Physician Burnout and Moyles on Suicide

January 25, 2024 /

From the Editor

Mindfulness programs, apps for sleep, resilience training. More and more corporations are offering these types of wellness interventions. Indeed, employee mental health services have become a billion-dollar industry. As reporter Ellen Barry recently observed in The New York Times: “These programs are a point of pride for forward-thinking human resource departments, evidence that employers care about their workers.” But are employees actually feeling better?

In a new paper for Industrial Relations Journal, William J. Fleming (of the University of Oxford) used survey data involving more than 46 000 British employees from 233 organizations, and considered several well-being efforts – including, yes, mindfulness programs, apps for sleep, and resilience training. He looked at several subjective well-being indicators. “Results suggest interventions are not providing additional or appropriate resources in response to job demands.” We look at the study and its implications.

In the second selection, Marcus V. Ortega (of Harvard University) and his co-authors look at physician burnout over time, drawing on US survey data for JAMA Network Open. With the pandemic, not unexpectedly, they found that physicians reported more burnout. “Findings of this survey study suggest that the physician burnout rate in the US is increasing.”

And in the third selection, author Trina Moyles writes about her brother and his suicide in a deeply personal essay for The Globe and Mail. She discusses her grief, the reaction of others, and her attempts at finding closure. She argues that we need to speak more openly about this topic. “Suicide: The word fires like a gunshot, so I’ve found myself whispering it.”

DG

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Reading of the Week: DBT for Youth with Bipolar – the New JAMA Psych Paper; Also, Involuntary Care and Dr. Gibbons on the Truths About Suicide

September 28, 2023 /

From the Editor

Nine! 

This month, the Reading of the Week celebrates a big birthday, its ninth. The first Reading was emailed out in September 2014. Many thanks for your ongoing interest and support. I’m looking forward to the next nine years.

Many young people with bipolar attempt suicide. What can be done to help them? In the first selection, Tina R. Goldstein (of the University of Pittsburgh) and her co-authors attempt to answer that question in a just-published JAMA Psychiatry paper. In their RCT involving youth with bipolar spectrum disorder, participants were enrolled in DBT or they received standard-of-care psychological support. “These findings support DBT as the first psychosocial intervention with demonstrated effects on suicidal behavior for adolescents with bipolar spectrum disorder.” We consider the paper and its clinical implications.

In the second selection, journalist and bestselling author Anna Mehler Paperny discusses coercive care in a new Quick Takes podcast interview. Mehler Paperny’s perspective on involuntary care is informed by her writing on the issue – and her lived experience. She worries that public debate may be driven by a desire to address public disorder rather than genuinely prioritizing the well-being of those with mental illness. “Coercive care is having a moment.”

And in the third selection, Dr. Rachel Gibbons (of the UK Royal College of Psychiatrists) considers suicide in a new BJPsych Bulletin paper. She opens by disclosing that three of her patients died by suicide early in her career. She then reviews “truths” about suicide. “In research we conducted, around two-thirds of psychiatrists and other clinicians felt it was their job to predict suicide. Our fantasy that we can do this, and our fear that we can’t, becomes a constant preoccupation in our work, distracts us from providing therapeutic care and closes our hearts to those in distress.”

DG

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Reading of the Week: Mindfulness Self-Help for Depression? The New JAMA Psych Study; Also, Elderly Overdoses (JAMA Psych) and Sanford on Loss (JAMA)

April 20, 2023 /

From the Editor

He diagnosed himself. My patient suspected something was wrong, did some reading, and then completed a PHQ-9 survey (which he found on a website). But, like many, he struggled to get care.

The story is too familiar. Access to care is deeply problematic. Not surprisingly, then, low-cost interventions are of interest, with much work focused on CBT. What about mindfulness? In the first selection, Clara Strauss (of the University of Sussex) and her co-authors attempt to answer that question with direct comparison of mindfulness and CBT. In a new JAMA Psychiatry paper, they find: “practitioner-supported [mindfulness] was superior to standard recommended treatment (ie, practitioner-supported CBT) for mild to moderate depression in terms of both clinical effectiveness and cost-effectiveness.” We consider the paper and its implications.

In the second selection, Keith Humphreys (of Stanford University) and Chelsea L. Shover (of the University of California, Los Angeles) look at overdose deaths in older Americans for JAMA Psychiatry. Drawing on a database, they find a quadrupling between 2002 and 2021. “Even though drug overdose remains an uncommon cause of death among older adults in the US, the quadrupling of fatal overdoses among older adults should be considered in evolving policies focused on the overdose epidemic.” 

And in the third selection, Dr. Ethan L. Sanford (of the University of Texas) writes about the loss of his infant daughter. In a deeply personal essay for JAMA, he describes her illness and death – and his re-evaluation of his career. “I sometimes wish every physician could understand the loss of a child. I wish they could understand how I miss Ceci achingly, how I miss her in my bones.”

DG

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Reading of the Week: Delirium in the ICU – the New NEJM Paper; Also, Admissions and COVID (CJP) and Dr. Boulay on Our Own (NEJM)

February 23, 2023 /

From the Editor

Is there a role for haloperidol in the treatment of delirium in ICU settings? That may seem like an unusual question since many patients receive this medication, perhaps half. But evidence is light.

In the first selection, Dr. Nina C. Andersen-Ranberg (of the University of Southern Denmark) and her co-authors consider ICU delirium with a new RCT, published in The New England Journal of Medicine. In this elegant study, half of the patients were randomized to receive haloperidol (in the IV form) and the other half received a placebo. They find: “Among patients in the ICU with delirium, treatment with haloperidol did not lead to a significantly greater number of days alive and out of the hospital at 90 days than placebo.” We consider the paper.

In the second selection, Dr. Scott B. Patten (of the University of Calgary) and his co-authors analyze hospital admissions and psychiatric diagnoses before and after the start of the pandemic. In this Canadian Journal of Psychiatry paper, they draw on Alberta data. Noting an existing literature on eating disorders, they also find an increase in patients with personality disorders being admitted. “[T]he increase was more pronounced than the widely reported increase in admissions for eating disorders.”

And, in the third selection, Dr. Richard M. Boulay (of St. Luke’s University Health Network) weighs in on physician mental health. In this highly personal New England Journal of Medicine paper, the gynecologic oncologist describes the problems of a second-year surgery resident who almost dies by suicide. He feels that she was failed by her program and medical culture itself. He writes: “[S]olutions are available. It’s time we began looking after our own.”

DG

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Reading of the Week: Twitter & Suicide – the New ANZJP Paper; Also, Crystal Meth Use (Quick Takes) and Patients and Physicians’ Names (JAMA Net Open)

October 20, 2022 /

From the Editor

More and more, people use social media to debate current events, share personal experiences, and maybe enjoy a cat video or two. But if people are disclosing much, are they discussing suicidal thoughts? Could certain social media posts encourage people to get help?

In the first selection, Dr. Thomas Niederkrotenthaler (of the Medical University of Vienna) and his co-authors attempt to answer these questions with a new paper just published in the Australian & New Zealand Journal of Psychiatry. Drawing on more than 7.15 million tweets (from Twitter) and employing a machine learning approach, they divide content into several categories, then review volumes of calls to a suicide hotline and completed suicides. “This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths.” We mull the paper and its implications.

Social media: more than cat videos?

In this week’s second selection, we consider a new Quick Takes podcast interview with Dr. David Castle (of the University of Toronto). Dr. Castle discusses crystal methamphetamine, a drug used more and more in Canada. Drawing on his Australian experience and noting the rise in use here, he comments: “it’s highly prevalent, highly available, highly pure and highly destructive.”

Finally, in the third selection, Dr. Jamison A. Harvey (of the Mayo Clinic) and her co-authors take a look at communication between patients and their physicians. Drawing on nearly 30,000 email messages, they consider the way patients address their physicians in a new JAMA Network Open research letter. “This is the first study to objectively identify patterns of addressing physicians through electronic messaging and may reveal potential bias. We found that women physicians… and primary care physicians were addressed by their first name more frequently.”

DG

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Reading of the Week: After COVID – the New Lancet Psychiatry Paper; Also, Clark on Therapy (QT) and Physicians, Heal Thyselves (JAMA Net Open)

September 1, 2022 /

From the Editor

The first reported cases were almost three years ago. Yet, with this pandemic, many questions remain. No wonder. The patient experience is so varied. Some of our patients complain of time-limited, mild symptoms. Others seem affected by ongoing, non-physical symptoms. And many haven’t had any symptoms.

How common are neurological and psychiatric problems? Do they last? Are they less common with newer variants? This week, in the first selection, we consider a new Lancet Psychiatry paper; Max Taquet (of the University of Oxford) and his co-authors try to answer these questions and others. Drawing on the health records of almost 1.3 million people with a recorded diagnosis of COVID-19 and focusing on 14 different outcomes (including anxiety and mood disorders) across eight nations, they find: “post-COVID neurological and psychiatric outcomes followed different risk trajectories: the risk of cognitive deficit, dementia, psychotic disorder, and epilepsy or seizures remained increased at 2 years after a COVID-19 diagnosis, while the risks of other diagnoses (notably, mood and anxiety disorders) subsided early and showed no overall excess over the 2-year follow-up.” We look at the paper and its clinical implications.

In this week’s second selection, we consider a new Quick Takes podcast interview with David Clark (of the University of Oxford). Prof. Clark speaks about IAPT, the UK’s program to expand access to psychotherapy, which he co-founded. “We’ve still got some distance to go, though, but the IAPT services are seeing about a million people a year who wouldn’t have previously had psychological therapy.”

Primary care has an essential role in our health care system. In the third selection, Emily Rhodes (of the Ottawa Hospital Research Institute) and her co-authors mull physicians and their personal connection to primary care in a new JAMA Network Open paper. They find: physicians are less likely to be rostered with family docs, and less likely to visit them. They conclude: “Emphasis on the importance and improvement of access to primary care for physicians is a potential means to improve overall health for physicians and patients.”

DG

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Reading of the Week: Suicide & Physicians – the New CJP Paper; Also, Cannabis and Psychiatry (BJP) and Tom Insel on Mental Health Care (Atlantic)

June 2, 2022 /

From the Editor

Despite what we may wish to believe, physicians are mortal. We can develop illnesses – even mental disorders. And some (too many) suicide. Past studies have shown that doctors die by suicide more than the general population. But the data wasn’t Canadian.

In the first selection, Dr. Manish M. Sood (of the University of Ottawa) and his co-authors consider suicide by Canadian physicians. In a new Canadian Journal of Psychiatry paper, they do a population-based, retrospective cohort study drawing on more than a decade and a half of data. They write: “Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians.” We look at the paper.

In the second selection, Dr. Julia Jiyeon Woo (of McMaster University) and her co-authors review cannabis from the perspectives of clinicians and patients. In a new British Journal of Psychiatry paper, they note: “This growing discrepancy between clinicians’ and patients’ perspectives on cannabinoids can be extremely damaging to the therapeutic alliance.” They offer practical suggestions.

And in the third selection, Dr. Thomas Insel (of the Steinberg Institute) considers what’s right and what’s wrong with mental health care. As the director of NIMH, he oversaw $20 billion of funding; in his new book, excerpted in the pages of The Atlantic, he calls for mental health reform. He writes: “There are only two kinds of families in America: those who are struggling with mental illness and those who are not struggling with mental illness yet. To ensure that we serve all families well, we don’t necessarily need to know more to do better.”

DG

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Reading of the Week: E-Cigs and Cessation – the New JAMA Paper; Also, Green Space & Schizophrenia (CJP) and Dr. Jessica Gregg on Needed Care (NEJM)

February 24, 2022 /

From the Editor

How to help him quit?

We often speak to our patients about the dangers of smoking – with middling success, especially with those who aren’t interested in cessation. Are e-cigarettes part of the solution? In a new JAMA Network Open paper, Karin A. Kasza (of the Roswell Park Comprehensive Cancer Center) and her co-authors report on a cohort study focused on this refractory population. “In this US nationally representative cohort study of 1600 adult daily cigarette smokers who did not initially use e-cigarettes and had no plans to ever quit smoking, subsequent daily e-cigarette use was significantly associated with an 8-fold greater odds of cigarette discontinuation compared with no e-cigarette use.”

In the second selection, we consider a new Canadian Journal of Psychiatry research letter. Dr. Martin Rotenberg (of the University of Toronto) and his co-authors look at green space and schizophrenia. A connection? They find one. “We found that residing in an area with the lowest amount of green space was associated with an increased risk of developing schizophrenia, independent of other sociodemographic and socioenvironmental factors.”

Finally, in the third selection, Dr. Jessica Gregg (of the Oregon Health and Science University) writes about her experiences as a physician and as a patient. In this New England of Journal paper, she talks personally about sudden illness and unsatisfactory health care. “I knew – and know – that our system of not-care for the sick and scared is broken. I knew – and know – that our system of un-care for people affected by addiction or poverty, for those who make bad choices and those who were never offered fair choices in the first place, is even more fractured.”

DG

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Reading of the Week: Better with Time? The New JAMA Paper on Stigma; Also, Dr. Steuber on Real Doctors – and Real Stigma (Academic Psych)

January 13, 2022 /

From the Editor

“To say that I didn’t know my great-uncle, Wolfe Levine, would understate things. I didn’t even know of such an uncle, brother of my mother’s father (a grandfather with whom I was close). In retrospect, it’s clear that my great-uncle was simply unmentionable.” In a long essay, writer Howard Husock notes that his great uncle, who suffered from mental illness, was never mentioned.

Society’s view of mental illness has changed much in recent years (good), but some stigma still exists (not so good). How have the public’s views shifted over time?

In our first selection, drawing from JAMA Network Open, we look at a new paper by Bernice A. Pescosolido (of Indiana University) and her co-authors. Reviewing attitudes and beliefs over 22 years, they find that: “this survey study found the first evidence of significant decreases in public stigma toward depression.” That said, not all the results are encouraging. We look at the paper and its clinical implications.

In the second selection, Dr. Elizabeth R. Steuber (of Johns Hopkins University) writes about the stigma faced by those in mental health care. Dr. Steuber, who is a resident of psychiatry, discusses the comments of a patient. She contemplates her work and the potential to change ongoing stigma: “I am hopeful that by leading through example on the medical floors, psychiatry trainees will continue to reshape how the field is seen by society at-large, even if it is only one patient at a time.”

DG

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Reading of the Week: How Will Venture Capital Change Psychiatry? Also, Gambling in Canada (CJP) and Dr. Bagley on Her Anxiety (JAMA)

May 6, 2021 /

From the Editor

Recently, one of patients raved about an app that she started to use. Talkspace offers her access to psychotherapy, unbound by geography, with a variety of therapist options.

The catch: she’s paying for it. In her opinion, it’s a good investment in her mental health. In Wall Street’s opinion, it’s a good investment in their financial health: that app has raised more than $110 million (USD) in venture capital. Other popular apps have also caught the eye and the backing of Wall Street – think Calm ($144 million USD) and Headspace ($167 million USD).

Is venture capital changing mental health care? And what are the potential problems? In the first selection, we consider a new Viewpoint paper by Drs. Ravi N. Shah (of Columbia University) and Obianuju O. Berry (of New York University). They write: “Although the value of this trend is yet to be fully realized, the rise in venture capital investment in mental health care offers an opportunity to scale treatments that work and address mental illness at the population level. However, quality control, privacy concerns, and severe mental illness are major issues that need to be addressed.”

wall-street

In our second selection, we look at a new paper by Robert J. Williams (of the University of Lethbridge) and his co-authors on gambling and problem gambling in Canada. Drawing on survey data, they find a surprising result: “Gambling and problem gambling have both decreased in Canada from 2002 to 2018 although the provincial patterns are quite similar between the 2 time periods.”

Finally, in our third selection, Dr. Sarah M. Bagley (of Boston University) discusses the problems of a newborn baby and its impact on his mother. The pediatrician isn’t writing about anyone – she is writing about her own experiences, and the resulting anxiety she experienced. “My story continues, but I hope that by sharing the issue of postpartum health can be better addressed among my colleagues and patients.”

DG

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