What actually is personalised medicine?

doctor baby adj

The latest buzz word in health care is to make it ‘personalised’. This word I have noticed is used interchangeably with ‘precision’ medicine. Precision medicine is where drugs are ideally chosen to be used dependent on the genetic profile of each person. But this is hardly personalised! It may be precise, but it is definitely not the definition of personal.

When I consider the term ‘personal’, I consider the person and what it is to be a person.

There is far more to our make up as people than our genetic makeup! We are whole people with feelings, thoughts, sensitivities, dreams, aspirations, relationships, jobs, families, children and a whole host of assorted issues and personalities. There is far more to being a person than our genetics, our gender, and our anatomic arrangements!

Making something personal, means that we are cared for as a whole, that our uniqueness is taken into consideration, and that treatments are tailored for us as a person. As a whole person, not just a set of genes, organs and blood tests.

The notion of personalised means that things become exactly that. Personal. Where you connect with and develop a relationship with your doctor or other health care provider. Where you and your practitioner are seen and respected for the people that you are. Continue reading

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Who took the Fun. out of Medicine?!

Alex funny doctor adj

If you go to any health care conference all around you, you will see a bunch of very serious professionals. Dedicated to their cause, they are taking it very seriously. It is rare to see anyone laughing, and conversations about health care and research matters are taken very seriously. People get upset about things, and they express their hurts, and sometimes, people storm out of meetings. It can be intense!

It is the same on hospital wards and in consulting rooms. Doctors as a rule are a very serious group of people. We are trained to be that way. You need to look serious to be taken seriously, or so we learn.

But what kind of a way is this to live life?

In all seriousness (yes, yes, pun intended ;)) why can we not have fun at work?

Why can we not have fun and enjoy ourselves when we discuss things?

Does it all have to be SO serious and intense?

Do we have to look serious and intense to show that we are paying serious attention to things? To show that we care?!

I wonder,

What might happen if we kept things light?

What might happen if we saw the lighter side of things when things didn’t seem quite right to us in a discussion about a certain matter?

And what if we kept things light when somebody dared to disagree with our point of view, in public of all things! As everyone knows in academia, differing opinions can be the start of a very intense exchange…

Yet, when we are born and we are small, we know how to enjoy life. We know how to laugh, and how to enjoy ourselves. It’s usually not a disaster if we fall over and make our bottom a little bit wet……. Small children naturally laugh with each other, unless they have been traumatised…

Is this perhaps what happens to us in the medical profession?

I wonder, do we perhaps become traumatised through the way that we are educated and trained, and through our professional experiences and use being ‘serious’ as a coping mechanism?

Is this perhaps one of our modes of defence and protection from trauma, our serious faces projecting out against the traumas of the world, both actual and perceived?

And what do we think our professional seriousness will prevent… Continue reading

What is our True Power as Physicians?

super flying dog

In Medicine we spend a lot of time learning about facts figures and statistics. We learn about guidelines, the Krebs cycle, the different types of renal tubular acidosis and the right drugs to prescribe under the right circumstances. We learn about the correct procedures and how to do good operations.

All of these things are vital and important in medicine, as if we do not get this stuff right, things go wrong for people.

But, are these things where our true power lies as physicians?

Much of what we learn is about function. It is about getting protocols right and following procedures. But these are all impersonal things.

What about the personal? Is that important?

After all, Medicine is fundamentally about people. It has care for people at its heart.

And as people, what is it that we seek when we are ill?

We naturally seek a true care. And not only care, we actually want to feel loved. Continue reading

Do we really need our doctors to be ‘resilient’?

haddock fight tough

When we think of the word ‘resilience’ it conjures up certain meanings. ie that no matter what is thrown at you, you can ‘handle it’. That you are tough enough to take it all on, and carry on.

Increasingly there are moves to train our doctors to be more ‘resilient’ to life, but is this really what is needed?

Burnout rates in the profession are utterly staggering. Over half of the medical profession. That is correct, over half of the medical profession are burnt out. 25% of the profession have thought of killing themselves at any one point in life. That’s right. A quarter of health care professionals, those trained to be our experts in health care have found life so miserable that their only way out has been to contemplate suicide.

Our suicide rates are far higher than any other section of society, the irony not being lost here as we are health care professionals.

The levels of bullying and harassment in our profession are rife, and increasingly doctors are beginning to speak up about the stresses and strains that they are under, and in the UK in particular, they are walking off the job to move to other countries where they feel more valued.

It is clear that as a profession our health and well-being is suffering. But is aiming for increased ‘resilience’ really the answer?

The sort of people who do medical school are by nature pretty ‘resilient’. They push themselves, deny themselves all sorts of things, in order to not only get the marks required for medical school but increasingly the vast array of extra-curricular activities that are required to demonstrate and prove that one is a suitably exceptional candidate.

Circumstances in medicine are certainly arduous.…..long hours of work, study for years on end, seeing people at their worst, a well established culture of bullying and harassment….Nobody ‘survives’ unless they have a degree of ‘resilience’ to human suffering, both their own, and others 😉

As doctors, we care deeply about people and innately and through our programming in medical school we want to take away human suffering. We see it as being a bad thing. Yet we quickly realise that the time that we have and the tools that we have in our medical armamentarium are not sufficient, and are woefully inadequate in comparison to the immensity of the human suffering that we are confronted with.

There is much to process in day to day life, in conjunction with the multitude of pressures, to do with time management, clinic hours, paperwork, and on top of that our life and family demands.

Many of us burnout and there are many things that people are pointing the finger to that are causing burnout.

Some people say its long hours, but its clearly not that, as many people work long hours with no burnout. There are clearly other factors at play and we are certainly affected by and react to the toxicity of the environments that we find ourselves in.

But is ‘resilience’ really what we need and what we truly want our doctor to be? Continue reading

Checking in – how well do you feel?

Ask a doctor adj

Most of us on a day to day basis just get through the day with The Big C –  That’s right: c.o.f.f.e.e.!!. The line up at the hospital café first thing in the morning before ward rounds is worse than peak hour traffic. There are mobile latte vans that visit our surgeries in private practice. We need our coffee. When we have breaks in the day, we have more coffee, and yes, we like the taste, and the smell, because its amazing!!! But, how well do we feel without our coffee? And that’s a telling point…..

If we are needing sugar and caffeine to get through the day, then there is something not quite right. Apart from its taste, it is a stimulant, it heightens the nervous system, and then it drops us again.

Animals don’t need stimulant drugs to make it through their days. Dogs do great without it. They’re pretty happy too. So, as an interesting note, why do we?!

Can we really say that we are living well and truly vital if we are needing stimulants to get through the day?!

The history of doctors and their association with stimulants is well known. Not, that it is something to aspire to, just something to be aware of 🙂 I once read that one of the founders of a famous US teaching hospital was addicted to cocaine having to give himself a dose each day just to function….I do not know for sure if that story is true, but as we know in medicine our rates of addiction are high, and they are not even measuring our addiction to caffeine… 🙂

Most of us are so used to feeling tired that we think it is normal. But, whilst it might be the norm in our profession, its actually is not natural to feel so tired and exhausted that you can’t get through a day without a stimulant! That is a sure sign that we are not as well as we could be. We’ve just become used to this way of living that it is ordinary for us, and its become a collective team activity at morning tea time, or post ward round….

As health care experts, why do we accept being so tired as our normal? Why are we tired only a few short hours after waking up when sleep is supposed to regenerate us and give us energy?

Can we say it is something of being truly well to need a drug like caffeine (as tasty as it is!) to keep us going?

Lets face it, as doctors, we are so used to dealing with the most horrendous diseases, that we consider that if we don’t have a disease that we must be well!

But being chronically tired, is not part of a state of well-being.

Being well is more than the absence of diagnosed disease.

To me, a state of well-being is feeling fully energized, joyful, vitalized on waking and during the day, having a sustained zest for life. It is a wonderful feeling on the inside, not just the absence of cancer.

Most of us feel grateful that we don’t have a horrible disease. But what if there was more to well-being than just not having disease! Continue reading

Hey doctors – can we care for ourselves?

doctor stethoscope adj

As doctors we spend all of our time learning to care for others.

Our entire education is spent learning all of the latest facts and figures and protocols so that we can provide the best possible health care for others. But in all of that, do we take the time to truly and deeply take care of ourselves? And if not, why not?!

Burnout rates in medicine are 40-55%. This is not just something to be a teeny little bit concerned about in the medical profession. This is a global pandemic! It is affecting literally more than half of the medical profession, globally.

It would seem in fact, that as doctors, everywhere, that we are not very good at taking care of ourselves.

In fact, our culture promotes the opposite.

what the adj

Our culture is about celebrating how tired we are, celebrating how much we can push ourselves beyond our limits. We celebrate and encourage black and dark humour which distances us from people. We celebrate sleep deprivation and long and hard work hours.  We decry sensitivity and feelings and distance ourselves from those inconvenient human sorts of things as much as possible and if we feel them we Never. Ever. Let on. that we are affected by things. Continue reading

Do we take the time to treat our patients?

doctor-patient adj

At a medical conference, for doctors, at the end of last year, we were informed in one talk that:

  1. Doctors don’t like treating patients
  2. They don’t have time for it
  3. They don’t do it well, and not only that
  4. They are not interested in doing it well

Needless to say as a person who loves medicine and people I was somewhat stunned (and I must confess, moderately incensed!) to be told from the pulpit so to speak, how I do and feel about my job from someone who has never met me or spent time in my clinic. And I am not alone in this response and feeling given the conversations I had with others who were in the same room as me when this invective was unleashed.

I heartily disagree with the statements that were presented to us. I personally feel they are coming from a burnt out jaded perspective, from someone who has given up on medicine and people in medicine. But this is not the first time I have been apprised of such attitudes in medicine. I have read papers that have said that doctors ought to have their attention focused on diagnosis only, rather than the day to day treatment of patients. And I have had conversations with peers who also feel that is where we need to have our attentions focused. Some people are proposing that doctors ought to ‘just diagnose’ and ‘other people’ ought to do the treating, following protocols, such as nurses.

It concerns me deeply to hear such perspectives gaining momentum and I am concerned for the future of health care and medicine.

Medicine is about people.

People are the heart of medicine. Continue reading

Is the Medical Profession in Crisis?

resuscitation adj

Across the globe, increasingly evidence is coming to light that people in our profession are suffering.

Its considered that we have about twice the rate of suicide as the general public. With reported rates being anywhere between 1.1-5.7 times higher than the general public6. It is known that our suicide rate is higher than any other professional group.

We have a higher rate of suicidal ideation than the general public, with 25% of doctors at any time having thought about killing themselves3. 10% in the last 12 months3.

We have a higher rate of both high psychological distress and higher rates of anxiety than the general public3.

We have far higher rates of burnout than anyone else in society. In fact, between 40-55% of the profession are burnt out with rates increasing over the last decade9. Burnout is not a benign condition. It is associated with exhaustion, depersonalisation and a feeling that the work is not worthwhile, and perceived errors. It is associated with higher rates of cardiovascular disease, depression, anxiety, diabetes, suicidal ideation and musculoskeletal complaints1. Furthermore, it is associated with higher rates of medical errors and lower rates of patient satisfaction2,7. Continue reading

Can we support one another in Medicine?

surgery-688378__480adj

In Medicine, we learn that life is about marks and doing work for patients. We are not taught to work together nor are we taught of the importance of working together in a collegiate manner. We are not taught to take care of ourselves or to take care of our colleagues. Too often there is open hate and hostility on display between doctors in hospitals and in private practice. Stress and tension run our relationships and very often judgement and condemnation of each other, whether vocalized or hidden, are the order of the day. In this day and age where the mental health of the profession is worse in many regards than that of the general public and suicide rates are higher than the general public, are our relationships with each other important in medicine?

I’ve been in Medicine now for over 20 years. One of the things that I have observed over the years is that our relationships with each other in Medicine are in general sadly not good. We are competitive. We work in isolation as a general rule. We don’t really support each other or ask for support, or allow support when it is on offer. We are the ones who are supposed to be ‘OK’. We learn to work with random people in teams in hospital and we keep the relationships ‘professional’ and consider them short term professional relationships that we have to ‘survive’! They are about work and they are about training. It is rare to develop relationships at work that are truly personal, ones where you feel truly safe where you can share and seek and give support and care that is non-judgmental. As doctors, we don’t let each other in, and we only share certain aspects of ourselves. We place huge expectations on ourselves and each other leaving little to no room for a true care.

In Medicine we learn that you have to be ‘tough to survive’. We learn to toughen up, and to not show any emotion. We pretend that we can ‘handle it all’. If we show that we are not able to ‘handle it’, then we learn that we are seen as defective, as a nuisance, and a problem who is not tough enough to handle it all. Those who are seen as weak in the profession are ostracized, eternally. I to this day remember a woman in my intern year who took a few days off ‘sick leave’ after a long stretch of days working, and was later seen down the street with her husband. She was judged within an inch of her life and complained about by many of the interns and she lost all credibility, forever. No care or concern was given towards her mental health and whether or not she was coping with the job or, whether she needed support. Support?! That thought never even entered our minds! The only focus was to judge her for not coming to work because she was clearly able to walk and to move and had not broken all 4 limbs.

And this is how it is in medicine. If you can breathe at least through one nostril, and stand up – at least on one leg, you must come to work no matter how you are feeling. There is no care and concern for how you are feeling. Mental and emotional health does not rate a mention. In retrospect, this woman was clearly struggling with the work and her life and she did the best thing she knew at the time to best support herself.  Looking back, she actually needed our support too! At the time she was judged and condemned as not being committed, as causing a strain on the rest of us who had to ‘pick up the slack’. And this is a common scenario in Medicine, more particularly in bigger institutions where people do not know one another. None of us took the time to consider the bigger picture, or to care for her health and well-being – as none of us took the time to take care of ourselves either. And how often does this happen in medicine when one part of the team is not doing well and the rest of the team instead of coming in to support and care simply judges and gets impatient? Continue reading

Why don’t we speak openly about doctor suicides?

depressed young doctor adj

Just over a week ago, I read an obituary in a medical publication about a young talented and clearly lovely junior doctor (not pictured above). Her life and achievements were celebrated, but naught to mention was made of the cause of her untimely death. Some colleagues and I surmised it was suicide, but then we wondered why it was it was not mentioned in the obituary?  At the time it felt as though there was an embargo on talking about doctor suicide, and we wondered why. There is a shame about discussing it in public, and if this is the case then how can we possibly learn about the things that lead to suicide in our colleagues? We discuss medical cases openly so that we might learn, but why not of our colleagues who reach a point of no return? Subsequently it has been confirmed in the media that the death was indeed a suicide, but it was not mentioned in the medical publication.

It is well known that doctors do have a higher rate of suicide than the general public. These results have been reported as being up to 5.7 times higher than the general public, with female doctors being at the greatest risk, with rates between 2.275.7 times higher than the general public. 

These results are quite staggering, but to speak truthfully, the fact that we have suicide at all in the profession is indicative of a deep dis-ease in our profession.

It concerns me to question:

How is it that can we have people who are caring and sensitive by nature, who choose to do medicine to care for people, ending up so despairing of life and caring so little for themselves that they take their own life?

And worse, that their colleagues and medical friends do not notice their decline to that point and are often completely surprised to hear of the death of a colleague in such a fashion.

How can this possibly occur in a system about health ‘care’?

These suicide statistics have been known for some time yet until now, no true action has been undertaken.

The NSW Health Minister has now instructed his staff that they have 1 month to find a solution to the doctor suicide crisis. It is great to see urgency brought to this matter, but is 1 month really enough and will it really get to the root of the cause? Continue reading