Tagphysicians

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

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.”

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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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Reading of the Week: The Resident’s Suicide – a New Paper from NEJM; Also, Help Seeking in Medical Education (JAMA Int Med)

From the Editor

“Bobby became my intern, and I was his senior resident. It was a role I cherished, and I tried to teach him all I could about caring for multiple sick patients simultaneously and navigating the systems, personalities, and politics of a large Manhattan hospital.”

Dr. Richard E. Leiter (of Harvard University) writes these words in a New England Journal of Medicine paper, this week’s first selection. He discusses loss – specifically, the death by suicide of the junior resident he was working with. On Twitter, Dr. Leiter commented that it took him six years to write about this death. Reading over the paper, we can understand why; the essay is deeply personal and moving. It also seeks to be constructive: Dr. Leiter calls for change. “Seeking to improve the lives of others shouldn’t cost our trainees their own.”

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Of course, the NEJM article isn’t just about Bobby; it touches on the culture of medicine. Suicide, while always tragic, is rare in health care; untreated depression and substance problems are too common. In the second selection this week, we consider a paper recently published in JAMA Internal Medicine. Dr. Erene Stergiopoulos (of the University of Toronto) and her co-authors note the mixed message of medical education: at once encouraging “wellness” but also criticizing time away. “Stigma surrounding depression is deeply embedded in medicine.” Importantly, Dr. Stergiopoulos and her co-authors makes three practical suggestions.

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On a pivot –

Since 2014, the Reading of the Week (ROTW) has been providing summaries and commentary on the latest in the psychiatric literature. Two years ago, we conducted a short survey to get your feedback. We are hoping to get more feedback to improve the Readings further.

We would invite you to join one of our online focus groups to hear your opinions and suggestions for improvement. If you are interested in participating, please email smit.mistry@camh.ca by April 12 with your preferred time slots from the following options – psychiatrists: April 21 at 4 pm or April 22 at 4 pm; residents: April 28 at 4 pm and April 29 at 4 pm. (Note: all times are in EST.) Time commitment: under an hour. If the above time slots do not work for you, please email Smit to arrange an interview time at your convenience, ideally between April 21 and April 30, 2021.

DG

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Reading of the Week: Lithium vs. Newer Meds for Bipolar – What’s Best? Also, Nudging Vaccines and Beale on Her Illness Experience & Being a Doctor (BMJ)

From the Editor

In the past, lithium had a large role – in the treatment of bipolar, yes, and before that, as a general remedy for a variety of conditions. Indeed, lithium could be found in various things, including pop (see the picture of the ad for 7 Up below). But times have changed. Lithium prescriptions are less common, and bipolar management increasingly involves other medications. (And, no, 7 Up doesn’t contain that salt anymore.)

How does lithium compare to these medications for people with bipolar? Dr. Jens Bohlken (of the University of Leipzig) and his co-authors do a retrospective study drawing on a national database from Germany. “When treatment failure was defined as discontinuing medication or the add-on of a mood stabilizer, or antipsychotic, antidepressant, or benzodiazepine, lithium appears to be more successful as monotherapy maintenance treatment than olanzapine, citalopram, quetiapine, valproate, and venlafaxine.” We look at the big study, and mull its implications on this side of the Atlantic.

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Can we nudge people to vaccinate? As the world works to get more shots in arms, Dr. Mitesh Patel (of the University of Pennsylvania) argues that behavioural economics will be important. In Nature, he writes that we have a golden opportunity to learn from the vaccine roll-out: “Each institution should report its vaccination efforts and performance, and conduct rapid experiments on how best to encourage people to get their vaccines – especially their second doses.”

Finally, some physicians have commented that being touched by illness has helped them become better doctors. Dr. Chloe Beale, a British psychiatrist, agrees to disagree in a blog for BMJ. “I can’t give the expected, tidy narrative of emerging stronger for having my illness.”

DG

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Reading of the Week: Physician Suicide – the New JAMA Psychiatry Paper and Editorial

From the Editor

“‘I Couldn’t Do Anything’: The Virus and an E.R. Doctor’s Suicide.”

So headlines a long article on the life and death of a New York doctor who had excelled at medicine – Dr. Lorna Breen oversaw an ER department, and was studying in a dual degree master’s program at Cornell University – but died during the COVID-19 pandemic. The front-page story ran last weekend in The New York Times.

Physician suicide. It’s a weighty topic, one that typically wasn’t discussed much in the past, in part because of the reluctance of physicians to acknowledge their own problems. But how often does it occur and is there a gender gap?

This week, we consider a new paper by Dr. Dante Duarte (of Harvard Medical School) and his co-authors. While previous papers have been published in this area, Duarte et al. are ambitious: they do a systematic review and meta-analysis of studies published over the last four decades. In the JAMA Psychiatry paper, they find: “suicide standardized morality ratios were high in female physicians and low in male physicians after 1980…”

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The paper runs with an editorial by Drs. Katherine J. Gold (of the University of Michigan) and Thomas L. Schwenk (of the University of Nevada). Putting the paper in a larger context, they write: “Suicide prevention is a moral responsibility of the entire medical profession.”

And a quick word of welcome to PGY1 residents who are joining us this week as part of our continued partnership with 12 Canadian residency programs from coast to coast to coast.

DG

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Reading of the Week: Dr. Norman Doidge’s Essay on Psychotherapy, and Responses

From the Editor

Earlier this month, the University of Toronto Department of Psychiatry held a one-day conference on the Future of Psychotherapy. Speakers included Harvard University’s Dr. Vikram Patel, who has worked to expand access to care in low-income countries, and the University of Oxford’s Dr. David Clark, who has co-led the world’s largest program to improve access to evidence-based psychotherapy.

Here in Ontario, the future of psychotherapy will be influenced by several factors, including government payment. The day after the conference, when Drs. Patel and Clark were travelling home, a long essay ran in The Globe and Mail discussing a provincial government proposal to limit physician compensation for psychotherapy to 24 sessions a year; currently, there are no restrictions on the number of psychotherapy sessions billable per patient, allowing public funding of psychoanalysis. Dr. Norman Doidge, a psychoanalyst with affiliation with both the University of Toronto and Columbia University, argues strongly against the proposal. Psychiatry, he writes, will be left with “diagnose, and adios” – or worse, “diagnose, overdose, and adios.” Dr. Doidge – a bestselling author who has written on topics as diverse as the Palestinian conflict and brain plasticity, and who wrote the introduction to Jordan Peterson’s popular book – puts forward a well-crafted case.

terapia-kxsb-u11004258755405xyb-1024x576lastampa-itThe past of psychotherapy – but not its future?

In this Reading, we consider Dr. Doidge’s essay and some responses to it.

DG

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Reading of the Week: How to Cope With a Patient’s Suicide? What to do When Nudges Don’t Work? Can Technology Bring Physicians Together?

From the Editor

“We talk about the toll suicide takes on families… We talk about the tragedy for the people who’ve died… What we don’t openly talk about is suicide’s toll on the doctors who have treated these patients.”

So writes Dr. Dinah Miller, a psychiatrist affiliated with Johns Hopkins Medicine. She discusses the death of a patient and the impact on her life.

Dr. Miller’s essay is one of three selections in this week’s Reading.

The papers are different and look at different issues. The one common thread: they were all published in The New England Journal of Medicine.

And they all ask important, thought-provoking questions:

How to cope with a patient’s suicide?

What to do when nudges don’t work?

Can technology bring physicians together?

p17Dr. Dinah Miller

Enjoy.

DG

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Reading of the Week: Is Cannabis Helpful? Can We Prevent Depression? What’s It Like to be Depressed & in Medicine?

From the Editor

In most Readings of the Week, a paper or essay is selected and then discussed. This week, we return to an older format, and look at several selections, offering an overview of a few topics.

The selections ask thought-provoking questions:

Is cannabis helpful?

Can we prevent depression?

What’s it like to be depressed – and in medicine?

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Cannabis: Hype or Help?

Enjoy.

DG

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Reading of the Week: How to Improve Depression Treatment? Cuijpers in JAMA. Also, Kurdyak on Access & Goodman on Mental Health Screening for Docs

From the Editor

This week, we consider three provocative but thoughtful essays.

In the first selection, Vrije Universiteit Amsterdam’s Pim Cuijpers – a highly published researcher in depression – wonders what needs to be done to improve depression outcomes. In this JAMA paper, he notes the importance of the task: “One estimate suggests that approximately 30% of patients with depressive disorders have a chronic course with limited response to treatment.”

ketamine-a-miracle-drug-for-depression-or-not-rm-1440x810Is ketamine a possible breakthrough for depression? Cuijpers ask.

In the second selection, the University of Toronto’s Dr. Paul Kurdyak considers how to address the shortage of psychiatrists – and notes, in this healthydebate.ca essay, that the problem is more complicated than some would suggest; he argues that the supply of psychiatrists across Ontario has little impact on access because of practice styles.

Finally, in the third selection, Columbia University’s Matthew L. Goldman and his co-authors note that doctors are screened for TB. They ask: “Should physicians also be screened for mental health conditions such as depression or burnout?”

DG

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Reading of the Week: Rahael Gupta on Medical Students & Depression (& her Depression)

From the Editor

Once—and I have never shared this before—I stepped into the street on my walk home from the library. I knew that the bus hurtling through the night would not have time to stop before colliding with my darkly dressed frame, fracturing my bones and scattering my belongings. I imagined my head hitting the asphalt and my brain banging around inside of my skull, bruising irreparably with each impact. I imagined the bus driver’s horror as he turned off the ignition with shaking hands and leapt out of the vehicle to locate my body. It would be a catastrophe that the trauma surgeons could not salvage. I would die.

Rahael Gupta is many things. She’s a graduate of Stanford University, and also Columbia. She’s a medical student. She’s a self-described optimistic. She’s a marathon runner.

And she’s a person who has struggled with depression.

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In this week’s Reading, we consider her essay in JAMA. It’s moving and clever and important.

DG

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Reading of the Week: Physician, Heal Thyself? The Gold et al. Study on Docs and Disclosure (and Mental Illness)

From the Editor

If you had depression, would you tell people?

This week’s Reading is a paper from General Hospital Psychiatry that considers just this question. In it, the authors surveyed American female physicians, asking about mental disorders and why they would or wouldn’t choose to get help – and to tell people.

Would you share your mental health history?

This paper is paired with an essay written by Dr. Nathaniel P. Morris, a Stanford resident of psychiatry, who mulls mental illness and disclosure – and has a big disclosure of his own.

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