SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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Likewise, Larry Cunningham DDS, MD (LMS President 2013), Chief of UK’s Division of Oral and Maxillofacial Surgery, is amazed by the pace of technological innovation and the unanticipated advances awaiting us in the future. He says, ”We can transplant almost anything.” In his field, the advances in dental, jaw and facial reconstruction are truly exciting. He admits this excitement is tempered for many physicians by the stresses and pressures of practice, the erosion of respect for physicians in some quarters, the large educational debt carried by many and the lack of physician input in many organizational decisions.


Neurosurgeon James Bean MD (LMS President 2001) echoes this deep admiration and respect for the technological and scientific advances in medicine generally and in his field in particular. “The genomic revolution with its personalized immunotherapeutic treatment of brain tumors and endovascular clot extraction for strokes are phenomenal. People with life-threatening conditions that would have killed them several years ago are walking out of the hospital now. I see very smart medical students more scientifically prepared than ever - some of whom have already written papers. They’re bright, motivated, altruistic and not so driven by commercial motivation. They seem to have a better understanding of work-life balance. Our neurosurgery training is improving- better documentation of milestones and objective ways to assess training goals. Yes, the EHR slows me down but it’s getting better and better and provides instant access to a wealth of patient information once you know how to access it.”


Lexington Clinic pulmonologist Bruce Broudy MD (LMS President 2012) says “In spite of it all, medicine is still an intellectually challenging field. Talented young people will continue to be challenged, stimulated and satisfied with careers in medicine. From the systems perspective, we see loss of control by physicians and often inane regulations. Still, we are dealing with the health of individual patients. The practice of medicine can still be stimulating and rewarding. It is still an inviting career compared to other professions. A lot of doctors’ children, including my own son, are still going into medicine.” Anesthesiologist Kathryn White MD (LMS President 2006), affiliated with St Joseph Hospital in Lexington, echoes the parental influence theme. “One of my children is a physician and another is in medical school. Both are enthusiastic about the future. Appalachian folks suffer from so many chronic diseases. The Affordable Care Act is an effort in the right direction and, though it needs changes, it shouldn’t be completely abandoned.”


Internist David Bensema MD (LMS President 2002) has been impressed with the caliber of medical students that have shadowed him in recent years. He is also impressed with the adaptability, creativity and entrepreneurship of his physician colleagues, some developing new IT or surgical products. He encourages physicians to get more involved in their medical staffs and professional organizations as a way to combat the demoralization that affects so many. He finds that those involved are in a better state of mind- whether born that way or as a benefit of collegial involvement.


Pathologist Terry Clark MD (LMS President 2003) describes as “almost unbelievable” the advances in genomics in the last 10 years. “If we can just create a financial model that makes these advances available to the population, we will see increasing patient benefits in transplantation, nerve regeneration and many possible uses of stem cells in multiple organ systems.” He thinks physician burnout is largely a generational thing. “I think burnout is going to burn itself out” as more physicians become employed. He believes late career physicians are more affected than early career physicians by practice stress and systems changes.


Emery Wilson MD (LMS President 2010), reproductive endocrinology and infertility specialist and former Dean of the UK College of Medicine, has a unique perspective on the course of medical technology and medical training. He sees a lot of medical school applicants and quips, “They are really intelligent young people. I was smart enough to be dean but I’m not smart enough to be a medical student today. ” He knows many of them have concerns about the future of medicine. When they ask physicians if they would go into medicine again, some say no. “But that’s asking the wrong question. If you ask physicians if they would give up the practice of medicine- almost everyone says no.” He believes every physician has an inspirational story- often about a patient that did surprisingly well.


He especially remembers covering the ER while in the Air Force and being called to see a man who had been shot and presented with no pulse. Even though trained in ob-gyn, he immediately noticed neck veins distended up to the man’s ears and diagnosed a hemopericardium. He picked up the largest syringe he could find, withdrew blood from the pericardium and, with the same syringe, injected the man’s own blood back into his veins. The patient was sitting up in bed eating breakfast the next morning. He also remembers receiving a call and expression of gratitude one day from a young woman who had just graduated from UK. She shared with him her plans to fulfill a long-time aspiration of becoming a physician assistant. This young woman was the progeny of the first successful in-vitro fertilization he had performed at UK in 1985. “The best way to think about the future of medicine is to look at the past. Penicillin was first used clinically in 1942. The Pap smear began to be widely used in the mid-1950s. The first in vitro fertilization procedure was performed at UK in 1985. Ninety percent of all we know in medicine has happened in our lifetime. It just makes you wonder how much we are going to learn in the future.


”He says that physicians are a very conservative group and resistant to change. But he says, ”It’s important to keep in mind the difference between what we do and how we do it. People will try to change HOW we do what we do, often in the name of quality of care- and some of that may be good. But they can’t change WHAT we do- we care for others. Nobody can change that. Considering the history of medicine and the quality of young people entering the profession- the future of medicine is secure.”


Hearing these answers from our LMS past presidents, I hope you feel that your cup is a little more full, that your professional community is supporting you and that there are many reasons to be optimistic about the future of medicine.     

Medicine has always attracted the best and the brightest. Most applicants to medical school are also inspired by a desire to be of genuine service and express their deepest human values through their professional lives. This ethic of altruism, compassion, meaning and service distinguishes medical students from most other professional students.


That makes it doubly tragic that some medical students, residents and practicing physicians suffer deeply from the demands of medical training and medical practice. Depression, anxiety, stress-related conditions, loss of meaning, thoughts of leaving medicine and suicide plague medical learners and practitioners alike - and the problem seems to be growing.


Psychological resilience is a measure of the degree to which one adapts to or recovers from external and internal stressors. Because psychological resilience mitigates the effects of stress, efforts to promote resilience at all levels of the medical profession abound. Without denying the profession’s stresses and problems, one resilience strategy is to focus on restoring meaning and joy, recovering passion and compassion, reigniting the fire in the belly and the flame in the heart for the practice of medicine.


Interestingly, the main determinant of resilience is one’s so-called ‘explanatory style.’ The way you think, whether your ‘cup is half full or half empty’, whether you are an optimist or a pessimist

BY JOHN A. PATTERSON MD, MSPH, FAAFP

determines the degree to which you adapt to life stresses in a healthy way or suffer from them in ways that degrade your personal life and professional work.


With that in mind, it seems useful to ask powerful questions that evoke the bright side of medicine, giving ourselves and our colleagues in medical training and medical practice an opportunity to promote resilience with a positive (‘cup is half full’) antidote to negativity and despair. This article contains the answers of several Lexington Medical Society past presidents to the question- What makes you optimistic about the future of medicine? I hope you enjoy their answers as much as I did.


Like several others, UK transplant nephrologist Tom Waid MD (LMS President 2014) is fascinated and inspired by the continued advances in medical research that help physicians treat disease processes more effectively and care for our patients more humanely. He adds, “ I'm optimistic that medicine will always be a profession that will attract the best and brightest minds and be able to improve the quality of life for many patients who historically have not enjoyed good health”

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org