Posted tagged ‘psychiatry’

I’m Glad I Took the Boards: Thoughts From a Board-Certified Psychiatrist

April 21, 2015

Recently there has been a great deal of controversy surrounding ABIM, the American Board of Internal Medicine, and its board certification requirements.  Currently the board require physicians to take an exam and recertify every 10 years in a process termed MOC, or Maintenance of Certification.  The process is time-consuming and costly, and many physicians claim it does not improve their day-to-day practice.  Doctors have become more vocal in their grievances with the organization, and its possible misuse of funds.

Despite all these criticisms, many physicians continue to comply with the process; not just internists, but in may other specialties, including psychiatry.  At a conference I recently attended, there was a booth set up by ABPN, the American Board of Psychiatry and Neurology.  The representative was there to answer questions for psychiatrists about board certification.  I learned that their requirements have changed, and that in 2020, when I would be up for recertification, I had new requirements to fulfill.  The requirements included performing activities comprised of continuing medical education, self-assessment, improvement in medical practice, and patient safety activities.  When I asked about the cost, the representative brightly told me that some of the modules “likely” have a cost associated with them.  She did not mention the cost of the actual exam.

Mind you, I am board certified in another specialty, Addiction Medicine.  Since I took the exam in 2012, in order to maintain my board-certification, I have to pay the board $400 every year.  This is in addition to the educational requirements I have to complete.

I mention all this not as a complaint, but rather because I’d like to offer another point of view.  Though some physicians could care less about diploma and the board certification it represents, it means a great deal to me.  The day I found out I passed the boards (and I was one of the last classes that had to undergo an oral exam), I was ecstatic. I felt that my hard work had paid off and that this piece of paper was tangible evidence of my journey.  It meant more to me than my residency graduation.

Not only did the exam feel like a milestone, but I felt that the work and effort I put into studying for it was actually useful. The field of psychiatry is constantly changing and I know that when it comes time to recertify, unless there is a viable alternative, I most likely will.  However, I feel that the money that goes into my educational requirements, the board review course I will take (not required but something I find useful), and the cost of the exam itself, will be money well spent.  I will study the topics covered by the exam and I will appreciate the knowledge that I will acquire.

And yes, I will hang up my new diploma.

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Keeping It Off

December 30, 2011

I found this NYT article yesterday about the difficulty of successful weight loss, and finally finished reading it today. I have been interested in this topic recently–the science behind weight loss. Partially I’m interested in this because there is increasing evidence that obesity has underlying biological factors that contribute to its epidemic; i.e. obesity is more like a disease, not a choice. The article is fairly long, but some of the more interesting points I found were the following:

1. There are hormonal changes after weight loss (lower peptide YY and leptin, higher ghrelin) that make it hard to keep the weight off (i.e. someone who used to weigh 150 pounds and now weighs 120 pounds, is different than someone who naturally weighs 120 pounds)

2. Some people have specific genes that make them more predisposed to eat higher calorie foods, and make it harder to lose and keep weight off

3. People who successfully keep weight off are the minority of those who try to lose weight, but they all have specific consistent habits, including tracking their food and exercise, weighing themselves daily, exercising daily, eating breakfast everyday, watching less TV, and not “cheating” on holidays and weekends

4. After weight loss, you are more susceptible to cravings than before (and this is shown on brain MRIs in research, and is some of the evidence behind obesity having similarities to addictions)

5. Knowing some of these things can help to improve ways of losing weight

Now after read this article I feel a bit more informed. It is easy to tell those who are obese to eat less and exercise more. While these tenets are still the core of achieving weight loss, we are starting to learn that not everyone has the ability or the genetics to do this things as effectively or efficiently. That being said, it’s not a reason to give. It may just be that we need to start approaching weight loss for people in a different light, for example slowing it down rather than speeding it up. Another reason to avoid those infomercials late at night!

Good luck and as always feel free to leave comments or feedback!

Really Destigmatizing Mental (and Medical) Illness

October 1, 2011

Recently I was asked to speak with a large group of resident physicians after one of their colleagues committed suicide the week prior. It was a hard discussion to have for a couple of reasons, including the fact that I had never done such a thing before. I had, however, gone through the same experience when I was in residency training–a colleague committed suicide when I was in residency as well. It was an event that impacted those that knew him, as well as those that did not. This is sadly a topic that is not discussed much–depression and suicide in physicians. Part of the difficulty in confronting this issue, is of course that doctors have a hard time asking for help for their own mental health. However, doctor’s rates of depression and suicide are higher than the general population–but on the other hand they have lower rates of cardiovascular disease.

One of the things I have personally struggled with during my training in medical school and residency, was dealing with depression. Unfortunately, although I was in a psychiatry residency, talking openly about being depressed was still a no-no. What it will take to destigmatize depression is being able to discuss it openly. So although it is hard, I will start in this forum. I have been depressed in the past. Finally after some time, at the encouragement of a friend years ago, I sought really good help for myself, and now I am a completely different person than I was back then.

I was also diagnosed with multiple sclerosis six months ago. This is another issue I have been struggling with, but in the past couple of months I feel I have been able to get a good handle on it, in particular by managing the things I still have control over. One of the things that I have learned though, is that I have an easier time talking to friends about having MS; I never talked that openly about depression. I was worried what others would think of me, that I would appear weak, and so on. I felt that way despite knowing so much about depression and why it happens, how it’s treated, and how it affects people. It has been a struggle dealing with all my health issues, but I’m so glad I’ve had the determination to do it. That being said, I’ve needed a lot of help along the way, and for that I’m grateful too.

If you think you might be depressed, tell someone. Ask for help. If the situation were reversed, wouldn’t you help the person asking? It’s hard to manage these things alone. Happy mental health everyone!

Everyone Needs Help Sometimes

September 21, 2011

The title of this post is something that’s often said to people who are having a hard time accepting help. Of course this statement is easier said than done. It is difficult for people, in particular independent people, to even acknowledge that they need help with something, let alone ask for it. I see this in the hospital at work with sick patients all the time, but it also happens in our day to day lives. Personal example: I recently hired a personal trainer. For me to outsource a task that in the past I have managed myself, was very difficult. I wondered why I wasn’t strong enough to address my health on my own. Well, whatever the answer to that question is, the more important issue at hand is that I get healthy one way or another. Hence, the trainer.

In any case, asking for help doesn’t make someone weak; truly I think it makes them strong. For someone to humble themselves enough to say “I need help–will you help me?” means that person is able to put aside their pride in order to meet a need. I don’t feel that I am incompetent because I need an expert’s help. I am good at what I do, and others are good at their job. And in cases of asking for a friend or family member’s help, I think it’s always important to remember that if the situation were reversed, you would be happy to do the same.

Just some food for thought–happy mental health!

Doctors Should Stop Wearing White Coats

September 8, 2011

I stopped wearing my white coat regularly about four years ago. I get questions from people at work about it all the time. Most commonly I get asked why it is that I don’t wear one. I admit, it might be easier for me if I did–and occasionally I will put it on, usually for an important meeting, or when I want to have a more authoritative role with a particular patient. A white coat makes a physician more recognizable as a doctor, and has big pockets, so a doctor can carry his or her important papers, reference books, and of course their cell phone.

That being said, I absolutely hate wearing my white coat. I have two of them, and find them to be a terrible nuisance. They get ring around the collar after one wearing, the smallest size could house a small football player, and can cause someone to be 10 degrees warmer, especially in a hospital where the air conditioning is unreliable, and the heat too high.

Also, and definitely most importantly, white coats are disgusting, and I mean that in a clinical way. White coats have been banned in the U.K. since 2007. While it is not clear whether the bacteria on white coats actually causes more infections in patients, to me it doesn’t matter. It gives me one more reason to not wear my white coat. Wearing one doesn’t make me a better doctor.

Mind Over Matter

August 2, 2011

I work in consults at my hospital, which means that I see medically sick patients who happen to have psychiatric issues going on as well. Common reasons I see patients are for drug or alcohol issues, depression, anxiety, and dementia. I enjoy this work because I really believe in the mind-body connection. For example, when someone’s depressed, they won’t be able to participate in their treatment as well, and physically may not get a whole lot better. Also, sick people get depressed about their health. I feel like I’m able to improve someone’s entire well-being when I address their mental health issues.

One thing that I like to discuss when seeing such patients, is what can the patient do to help themselves in the hospital. A lot of times, we may start a medication, or we may provide supportive therapy in the hospital, but treatment always takes time. While waiting for treatment to start working, what can the patient do on their own in the meantime to start getting better? An expression I like to encourage patients with, is “Fake it til you make it.” Even if someone does not feel at his best, he can remind himself that eventually, things will improve–so in the mean time, why not put in a little more effort, even when it’s hard. Sometimes this works, sometimes it doesn’t, but at least the patient feels he has some control over his own situation. This in itself can be very empowering.

Just some thoughts after a day of seeing patients today. Thanks for reading, and as always I welcome any comments or questions.

Patients, Rights, and Choices

July 20, 2011

I am off from work today, and what do I find myself doing, but reading some material for work! This is a very different experience from when I was in residency, when catching up on sleep was always my number one priority outside of the hospital. Recently I’ve been reading about patient autonomy and their rights to make their own choice. I’ve had a couple of challenging cases recently, in which there was disagreement about whether a patient was “competent” to make his own choice. I used to think this was a cut and dry issue–either a patient does or doesn’t understand their options. What I’m starting to realize, however, is that so many other considerations have to be made. For example, what values and principles has the patient used to guide them in the past? It should come as no surprise, then, when a long-time poorly controlled diabetic, who now needs a life-saving amputation, refuses the surgery. He has not taken care of his health in the past, and is not interested in complying with the after-care required to recover well. However, it is difficult for doctors, who value health, and have been trained to sustain and prolong life, to understand this decision. Would it make a difference if the patient’s mother had an a similar amputation 30 years ago, and died two weeks after?

It’s difficult to allow a patient to make a choice that may not be in his best interest, but that’s an internal struggle physicians have to manage, and not allow it to interfere with patient autonomy, and more importantly, their respect for the patient. This is not to say all decisions are life and death. Often I am asked to see medically ill patients who are quite depressed and would benefit from treatment–and in fact, treating the depression would improve outcome for the medical issues as well. Sometimes patients choose to try treatment, and other times they say no. I try to educate patients about myths related to medication (they’re addictive, mind-altering, etc.). We also discuss alternatives to medication, such as therapy. In some instances though, the patient is very well-informed, and simply does not want to take medications for one reason or another. It’s something that needs to be accepted–that every person comes with a unique set of personal values and principles that he lives by, and it may be different than yours or mine.