On parenting.

My child psychiatry rotation opened my eyes into the daily struggles of children and adolescents in the midwest.  My previous post shares some of my experience and insight into mental illness. While I expected to learn more about what crosses a child’s mind, I was never expecting to gain an understanding of how parents view their children and vice versa. Sitting in on psychiatric evaluations of kids and their families gave me a lot of perspective on the disconnect between them. Hearing their hugely different takes on situations gave me some insight on where the discord arises from. I wrote some notes to myself for future reference that I’m hoping will help someone here.

Disclaimer: I have no children of my own and am years away from realistically considering having kids. Please take any advice in that context.

1. Inconsistent parenting often leads to impulsive kids.

Divorce is an incredibly difficult thing for families to go through. Often times they both want the best for their children, but have different styles of parenting. One house may have a certain set of more rules while another may offer children more independence. This creates a sense of disrespect towards rules and authority. There were many kids that I saw that felt as though they did not know how to control their angry, impulsive behavior because it was tolerated at one household. Even in families with parents that had good communication, children often acted out if rewards and punishments were poorly enforced. I noticed that kids that had good impulse control and respect towards others came from households with consistent rules that were enforced in all environments. The key in treating patients with oppositional defiant disorder was providing a structured environment and giving them a chance to prove themselves with some responsibility.

2. Rewards are more powerful motivators than punishments.

As mentioned above, kids think in extremes. So when their punishment lasts any period of time longer than 2-3 days, they feel as though they’re *never* getting rid of their punishment. They lose focus quickly and go back to acting out and repeating the behaviors that got them in trouble in the first place. I’ve noticed that it is much more effective to reward kids for positive actions. It is crucial remind them that their possessions are earned rewards and not necessities. That way when they break a household rule, they feel that they no longer earn their reward of independence or having a cell phone. Keeping them on a short timeline and providing details about how they can earn back their rewards seemed highly effective for most kids.

3. Kids have an “all or nothing” mentality about most things.

I found it amazing how quickly kids could change from hating their moms back to loving them after she returned their phones to them. Kids love using extremes like always, never, love, and hate. I’m not quite sure when they start to understand the spectrum of emotions, but for a vast majority of childhood everyone is simply “good” or “bad”. So when they say they hate you, try not to take it personally. They often don’t realize the gravity of the words they use and think the point of arguments is to be as insulting as possible. They’re just kids and they’ll go back to loving you before you know it. Kids have incredibly large egos and it often takes adults to be the first to show affection and open doors of communication.

 

4. Electronics give kids unlimited access to the world. 

Nowadays kids are influenced by all sorts of things. It is so easy for a kid to ignore everything a parent says and subscribe to one quote that they read online written by a complete stranger. In a world where cell phones and iPods are being given to kids younger and younger, this makes for a dangerous combination. While on child psychiatry, I noticed that a lot of kids had extensive communication with strangers online to whom they confided in. Much of this was without their parent’s knowledge. Between sneaking downstairs when they thought their parents were sleeping and telling their parents their iPods didn’t have texting, kids find a way to get online. My advice to parents is to educate them about the danger of what they find online and to try to keep as close of an eye on their electronic and social media use as possible. I noticed that some parents had their kids turn in all of their electronic devices before bedtime and had conversations with their kids about the websites they were allowed to visit. These families had far less incidents of kids finding things online not intended for their eyes.

5. Peer pressure is a strong motivator. 

Depression is an isolating disease, yet many kids find that when depressed they want to relate with their peers that feel the same way. In relating to other kids, they get inspired to self-treat their depression or anxiety.There are many groups on the internet where adolescents take pride in cutting themselves. It is not uncommon to see kids running into another kid who self-harms and being inspired. Similarly, adolescents commonly normalize their thoughts of suicide and harming themselves. They confide in other peers going through similar emotions and don’t turn to adults for help. This creates an environment in which kids don’t realize their depression is getting the best of them and don’t reach out for help.

My biggest advice to parents suspecting that their kids may be depressed: ask them if they’ve thought of harming themselves and if yes, get them to a hospital ASAP.

 

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On mental illness.

I was incredibly nervous going into my first day in the inpatient child/adolescent psychiatry unit. “Was this where the truly psychotic kids are? Am I going to be safe here?,” I wondered as I casually introduced myself to the staff on the floor. After a morning of sitting in on group therapy led by psychologists and occupational therapists, I calmed down. Against the backdrop of the soothing soft pastel colors, I began to forget that I was even in a hospital and not an outpatient clinic.

I was expecting to see he stereotypical patient mumbling to themselves or trying to injure themselves in the dark corner of the hospital floor. However, I found that the hospitalized psych patients were shockingly normal. Though some kids were rough around the edges, there was nothing immediately threatening about the majority of them. They were the standard middle and high schoolers that had many of the same concerns expected for their age. They had issues relating to their parents, stress due to schoolwork, and drama with their friends. They weren’t so “crazy”.

A 15 year old shared her concerns about her depressed mood following a recent break-up. She had thoughts of committing suicide, but knew she wouldn’t actually act on it. She told her parents who brought her in. She described her stressors and they echoed similar experiences that I had faced in high school. Hearing her story made me think the patients in the psych unit must all be similar to their peers, but had simply gotten caught up in life stress. As she shared her mood symptoms, I began to check off the symptoms needed to diagnose depression. Proud of myself for identifying a textbook case of major depressive disorder, I excitedly presented the case to my preceptor and left with a sigh or relief.

Day 2 was drastically different.

5 minutes into group therapy, an agitated 12 year old patient started running around. “Some kids just can’t sit still. He’ll calm down,” I thought to myself as I tried to redirect him. I focused on getting other children in the group to share what brought them to the unit while the 12 year old started pacing back and forth and fixating on me. He suddenly stared blankly at my bright blue necklace. Before I could react, he ran over and grabbed me by my necklace. He began to pull me down by the neck while jerking violently at my necklace. I struggled to gasp for air as a behavioral health tech tackled him down and a nurse called for security.

He swung me off my stool and my head hit the floor. Pain and shock followed.

While I was being evaluated in the ER, I became upset at myself for letting my guard down. The 12 year old was quiet and depressed just yesterday. I had no idea that he would be manic today. I became distressed that I hadn’t take more caution to see the attack coming and avoid it. The patient who had attacked me was diagnosed with ADHD, bipolar disorder, and oppositional defiant disorder. Impulsive behavior, psychotic episodes, and acting out towards authority figures are not uncommon in those conditions. I felt that I should have better predicted his actions due to his diagnoses.

It took a couple of weeks and involvement in a psychotic break, but the stigma I held towards mental illness slowly began to fade. I stopped viewing it as just a deviation from normal behavior. In the days following the attack, I learned more about the subtleties of the patients’ conditions. I saw that not all depression presented the same and that psychosis was often completely unexpected. I came to understand that a patient’s diagnosis didn’t make their behavior predictable and that I couldn’t hold myself responsible for the 12 year old’s actions. Just as in other areas of medicine, a patient can easily be misdiagnosed and therefore receive improper treatment.

I learned many valuable lessons on the inpatient psychiatry unit. The biggest one was that  will continue to resonate with me lifelong is that mental illness affects everyone differently. A person’s depression can affect them drastically differently than their family members who previously received the same diagnosis. People’s mental illnesses are just as unique as them. As a medical student I often want to apply textbook knowledge to take inventory of a patient’s symptoms and assign a diagnosis. I have to take a step back and realize that there is so much more behind mental illness than a DSM code. I’ve come to learn that even when stressors, strengths, and weaknesses are shared, it can have a different effect on each person.

The similarity between all of the patients I saw was that they could all be helped in some way. While psychiatric evaluation and medications were the keys to their improvement, empathetic listening often played a large role in many of their treatments. I have great admiration for those who dedicate their lives to helping the mentally ill. I hope to approach all of my future patients with the same nonjudgemental and patient attitudes I witnessed in many of the staff I worked with.

On antivaxer parents.

When you hear the words “I don’t want to vaccinate my kid. Why would I give them autism?” It’s hard not to get upset and meet your patients with some judgement.

John and Carly were middle-class Americans that had a lot of misconceptions about vaccines, mostly from the media. They loved their 2 year old daughter, Leslie, and wanted the best for her. They didn’t understand that we wanted the same thing. They met me with resistance when I told that there must be an issue because I couldn’t find Leslie’s vaccination records.

“There’s no issue. She isn’t getting vaccinated. She never has and never will”, they stated matter-of-factly. I blinked twice and slowly let the judgement fade from my mind. Surely there had to be a good reason for this. “Why are you opposed to vaccines?”, I asked.  “We’ve honestly never been asked that. Most docs just shake their heads at us, give us a speech, and move on.”, they replied.

I worked with them to understand what their reservations were. It seemed that their concerns stemmed from media articles linking vaccines with autism and neurocognitive issues. They were also skeptical about the government and CDC recommendations because they worried about the motives behind official vaccination guidelines. I pulled up www.chop.edu (a nongovernment sponsored website) and went to the vaccine education center and walked through what all of the vaccines contained and adverse affects. The CHOP website has good evidence based info negating any correlation between vaccines and autism and isn’t sponsored by the CDC.

I also talked to them about what diseases the vaccines would prevent and how not immunizing puts their kid of spreading diseases to immunocompromised children. They seemed to finally come around when I said “I’m not just saying all of this as a medical student but as someone who doesn’t want to see your kid get life threatening meningitis or polio”

I was amazed at how much they were willing to listen and go through every ingredient and potential side effect of all of the vaccines Leslie was due for. They opposed getting all of the required vaccines right away, but agreed to start her a late vaccination schedule. John and Carly thanked me repeatedly for taking the time to sit with them and educate them. They told me that they were often met with discrimination when healthcare workers found out that they were anti-vaxers. They never felt as though they could properly explain their hesitations.

My call to action to anyone dealing with anti-vaxer parents is to take the time to understand and address their hesitations. While some parents will not be easily convinced, it is worthwhile to spend the extra time to hear them out and educate them. I hope this website helps other healthcare workers provide a good resource to patients: http://www.chop.edu/centers-programs/vaccine-education-center/resources

On America’s future.

I have a memory of feeling overwhelming anger and animosity as a 10 year old. I was holding my father’s spot in the checkout line at Walmart in rural Illinois as he ran to grab the paper towels he had forgotten. He quickly darted back in line into the spot that I had saved him as he knew leaving me surrounded by candy for longer than a couple of minutes would be a bad idea. The elderly white woman behind us who I had barely noticed earlier tapped me on my shoulder. Surprised at what this stranger might want, I turned back and smiled at her. She met my smile with a scowl. In between curse words she furiously yelled, “from our jobs to our spots in the grocery line you guys will stop at nothing! Go back to your country!”

I was confused and hurt. I wanted to retaliate so badly, but I kept quiet and pretended to ignore her. Her anger bubbled more and more and then she struck me with her cane while yelling racist comments. My father turned back at her and protected me. He said to her, “She’s just a kid. Leave her out of it.” I was so lost. I felt like I missed something. Leave me out of what? Why was this woman so mad? 

Growing up in a conservative predominantly Caucasian neighborhood, incidents like this were not uncommon. I remembered back to what my mother would tell me often; “You have a right to be angry. You are right to feel upset. What you don’t have a right to do is to act blindly on your feelings.You cannot turn your anger into violent actions and not think about how it affects others.”

The results of the 2016 presidential elections have brought back a lot of the feelings that I had towards oppressors I have faced in rural Illinois. It’s hard not to join the millions of other Americans who feel angry and let down by the results of the election. Being a liberal first generation immigrant, I naturally disagree with many of Trump’s policies on healthcare, economics, and immigration. I have a lot of fear about what America’s future will look like under his presidency. I worry about what my future in medicine, as a woman, and as an immigrant will look like.

What makes me even more angry are people’s actions as a result of this election. Reading about xenophobic events across the country on the twitter feed titled “Day 1 in Trump’s America” is incredibly discouraging. It feels like we have taken 10 steps back in all of the progress our country has made in embracing diversity with an open mind. Read here: https://twitter.com/i/moments/796417517157830656

I realize that many others have the same fears about America’s future. Regardless of how we feel about the election, we cannot allow our fear and our anger to be turned into violence. The hospital where I am currently rotating has been busier than ever with the consequences of the not so peaceful protests in Chicago. Trump supporters and haters are both getting ostracized by the other for their beliefs. Turning on the news nightly makes me realize that anger is turning into violence on a national level. As much as I want to show my disappointment in the man that has been elected president, I am frustrated with how people have been expressing themselves.

Realizing that Trump is now in a position of power and already spreading ideology similar to the woman who attacked me with her cane when I was 10 is scary. I hope no one has to face the racism and hatred that I experienced in that movement. However these xenophobic instances makes me realize that it is up to us to inspire change and react with graciousness. The violence that has been brought on by both anti & pro Trump protesters has gotten out of hand. Now more than ever, I think back to my mother’s words. You cannot turn your anger into violent actions and not think about how it affects others. 

While it is naive to think that Trump will not make major change in the country, it is important to realize that we still live in a government with checks and balances. Our democracy gives us power to help influence policy by writing to state-elected officials. I hope that utilizing this power will further our ideas rather than attending protests that can get out of hand.

One of my major issues with Trump’s policies is his stance on healthcare. Trump plans to repeal Obamacare and implement a free-market healthcare plan. Free-market healthcare increases the corporate power given to large healthcare organizations and will almost definitely drive the cost of healthcare up to the average American citizen. More of the money spent in healthcare will be distributed to administrators and corporate professionals. This will surely discourage many patients from seeking treatment for their conditions  and leave the poor uninsured because they simply can’t afford the premiums.

While Obamacare has had many flaws, it has insured many previously uninsured and underinsured citizens. It has helped bridge the gap in healthcare disparity between the rich and poor. One of the reasons I chose to go into medicine is because I believe that healthcare should be a fundamental right as a human. I believe that the opportunity to live a healthy life should not be dependent on socioeconomic status. It is disheartening to think that I may not be able to treat certain patients just because of their lack of insurance.

There is still much speculation on how medicaid, medicare, and women’s health will be affected. This article rounds up the possibilities well: http://www.medpagetoday.com/Washington-Watch/ElectionCoverage/61321

Some issues that I have written to legislators about recently are expanding healthcare into a single-payer system. Though the future of healthcare often feels grim, it is up to us to stand up for the ideas we believe in. Single-payer offers a universal healthcare system that does not limit people’s access to the healthcare system based on their socioeconomic status. Patient’s hesitations to recieve the medical care they require due to financial burdens will be less of an issue under this system. My biggest goal is to inspire change in the system in a positive and peaceful manner. If you are interested in supporting single-payer or learning more, please visit this website: http://www.pnhp.org/facts/what-is-single-payer

On writing.

Over the past month, I’ve slowly rediscovered my love for writing. Though I have never considered myself a strong writer, I have fond memories of it providing an outlet for my thoughts. The history essays that everyone dreaded writing in high school were some of my favorite assignments. I spent days wording and rewording my sentences while my classmates wrote them quickly the night before they were due. It felt exciting to produce a piece of work that I could read over and over again. Sometimes I wish I could go back to having writing assignments. With the hectic schedule of undergrad and medical school, I have abandoned my creative outlet for many years.

While in Oregon, I had some time for introspection. I realized that I needed an outlet for my energy otherwise I would internalize my emotions as I had been for so long. For me writing is a way not only to better define my feelings and memories, but to release them into the world. I often feel that writing about the experiences that have held me down help me to feel less burdened by them. It wasn’t until a month ago that I realized the therapeutic value of journaling. I journal both the good and the bad–the things that excite me and the things that frustrate me. Putting both down make me feel balanced and allow me to let go of extra energy.

Recently, I have started writing a series of letters. These are letters that I will likely never send to their intended recipients. The most freeing one to write was to my uncle who passed away a few months ago to alcohol related cirrhosis. I forgave him for his addiction and his actions. I shared with him my fond memories of him treating me to great home-cooked meals whenever I visited him. I wrote it as though he could respond and write back. It helped me say goodbye in my own manner.

I’ve written another letter to an attending physician whom I recently trained under. I wrote about how I felt so out of touch with humanity while working with her. I revealed that her many “business” oriented lectures to me revealed how her concern for money seemed greater than her concern about her patient’s lives.  I told her that I was disappointed in the care she was providing her patients. I admitted to her how much I struggled with my worries that I would end up just like her – overworked and jaded by the medical training process. While that letter may never reach her eyes, writing it helped free me. It freed me of some of the pain that had come along from that experience.

I wrote good things about her to balance things out. I wrote about how I liked that she squeezed her patient’s hands whenever she was about to give them bad news. I wrote about how she always made sure to show her nurses that they were appreciated. I could tell that she loved to teach me and other medical students but was jaded by her own experiences growing up in a household of physicians and constantly being bombarded with medical facts. I realized then that working with her, though miserable at the time, provided me with a great experience. Rereading it helped me realize that I had the opportunity to learn from her mistakes and ensure that I wouldn’t make similar ones.

I don’t think writing is necessarily a good release for everyone. Most people I know don’t enjoy doing it and therefore it becomes more of a task than a therapeutic outlet. But in case you’re like me – a previous lover of writing, I encourage picking it back up. Whether in medicine or not, we have to find ways to stay sane and enjoy life. Writing has helped me hold onto my humanity and release my frustrations into the world. For many other people, their creative outlet is in music or the arts. I hope that this post inspires you to revisit those outlets and spend time doing the things you once loved or discovering new talents.

Medicine has a universal way of suppressing free time and making it hard to meet your personal goals of staying healthy. As much as we make time for physical activity and eating well, I believe that it’s just as important to have time to ourselves exploring our hobbies. We have to find ways to maintain our sanities while navigating our professional lives. I hope to continue with writing in attempts to do just that. My call to action to other medical students is to find a mental release and rid yourselves of all of the burdens that come along with medical training.

On what I learned from Eli and Dylan.

When I was heading to a retreat held by the physician who started the ideal medical care movement, Dr. Pamela Wible, I expected an orderly and structured program on how to improve the current culture of medicine. I knew with about 40 physicians and 10 other medical students, there would be a lot of type A personalities since that’s typically the sort of people that go into medicine. While I did receive the systematic instruction that I had hoped, I learned so much more than I ever expected.

When I got to the hot springs retreat in Oregon, I wasn’t quite sure what I had gotten myself into. It was the complete opposite of what I had expected. Type A personalities seemed like they lived many, many miles away. There were hippies everywhere, clothing was optional, and all of the meals were vegetarian. It felt so unlike the conservative pace of the midwest. The thing that I found the most astounding was the abundance of clean air and the feeling of being one with nature. Having grown up in a small town with frequent trips to the nearby river and opportunities to hike in trails nearby, I felt right at home.

It felt as though I had left all of the hierarchy and protocols that come along with medical education behind. For example, when I had been in therapy, I often felt as though I was talking to a clipboard. While my counselor was great at giving me specific structure on how to proceed with my life, I wondered if following the protocol would really work for me. I went inconsistently to therapy or to talk to another professional about my mental health issues because I felt that it was useless. I was battling regret about my past, anxiety about my future, and feeling hopeless in between. The stress of medical school and a failed relationship with someone whom I once thought I would be spending my life with didn’t help. I didn’t want to be on another medication, but I didn’t know how to address the issues I was battling. I felt like I was going to explode.

Having a history of some social anxiety, I never thought that I would befriend an outgoing couple in the middle of nowhere, Oregon. I entered a hot tub on my last night in Oregon with two people that I initially thought were physicians that were attending the same retreat. I quickly realized that their voices were strange and that they weren’t part of the retreat. I got over my fears and began opening up to them, which was unlike my norm of being guarded with strangers. I told them about my worry of being forced to practice medicine in a way that I wasn’t okay with. I told them fears of becoming someone my parents don’t approve of. I revealed to them some of my biggest regrets and fears.

They owed me nothing, they didn’t even know me before that night. Yet they were kind and sincere to me in a way that I hadn’t experienced in a long while. They calmly listened and gave me advice in a nurturing and encouraging manner. They drew upon their own experiences and related with me. We had a genuine conversation and I gave them advice on turning their skills into a business to help other people like myself. No one was worried about the time or taking notes. It was one of most therapeutic nights in my life. I have a feeling that I will never forget the guidance and courage they gave me that night.

I definitely never thought that Eli and Dylan would help me gain more insight on things I had been struggling with than the professional I had seen a couple of times in the Midwest. I have made more progress towards a healthy mindset with the advice that I had received from them than advice I’ve gotten from anyone else. I am no where near close to solving all of my mental health issues, but I’m at a better place than I was before. I still have days that I have battles with myself, but I notice that these days are more and more infrequent. For the first time in a while, I feel in control of my life and my future.

Eli and Dylan taught me that you don’t need to have a degree or title to be a healer. They also taught me that those with degrees and titles aren’t necessarily the kind-hearted people we expect to encounter sometimes. It feels far too often that I meet physicians who have lost some humanity from all of the protocols that they have been forced to comply with. I came to find a new perspective on mental health and well being from two healers that came from backgrounds so unlike my own. They were not following algorithms or protocols in treating patients, they were just being themselves– kind and sincere individuals that genuinely wanted to help others.

I want to thank Eli and Dylan for teaching me that sometimes the best medicine is a genuine conversation. I hope I can find the compassion that you two have and convey it to my future patients. Thank you guys.

 

On exams.

If you are in the field of medicine, you more than likely have had a negative experience taking an exam. The hatred for the certification exams students, residents, and physicians have to take seems universal.

After a constant stream of academic exams in medical school, I started to hate the testing process. Between the fatigue and anxiety that came along with each one, I never felt like I fully acclimated to the stressful environment of test taking. Having been a good student in college, this was a new feeling for me.

I went from telling myself “you’ll have plenty of opportunities to do better if this exam doesn’t go well” to “oh god this feels like the millionth test I’ve taken.. when will it end?” in a matter of just a few exams. There were so many days that my mind would wander when I should’ve been studying. I would wonder how much money and time I had invested into my medical education. I kept telling myself that I had invested too much of myself to back out now. It felt like as soon as one exam would end there was so much work in other classes to catch up on.

For the first year of medical school it felt like it was an endless cycle of focusing on one subject, cramming for the exam, and paying attention to the other subjects that I had blown off for a week. I didn’t feel like I started to understand concepts until halfway through my second year. Even then, it felt more like connecting random facts together rather than understanding the bigger picture. It felt like I would learn mundane details, dump them onto an exam and out of my brain, and have to keep learning the same details. I didn’t understand how to be an efficient learner in classes until I started exploring sources outside of class including educational videos and question banks.

When I started After taking my COMLEX level one and USMLE step one, I was left with very little energy and motivation to succeed on the first rotation that I had started. I felt like I had just gone through a traumatic event and needed months to recover from the PTSD from the 18 hour study days. I have only met a handful of people who enjoy being tested in a comprehensive way that can be incredibly draining to prepare for. While I feel like I did learn a lot, I can’t help but wonder if there’s a more efficient way to test medical students while preserving their mental health.

My call to action to other medical students who feel just as exhausted as me from exams is this: take care of yourself through the grueling process of exam preparation and reach out for help if you need it. Rather than an impossible task standing in your way of becoming a physician, view them hoops to jump through. I know it can be incredibly hard to preserve your sanity during these exams, but it honestly does get better once you enter your clinical years. I know that I still have plenty more exams to take, but it has been getting easier with each one. Taking study breaks, finding time to eat healthy and exercise, and having strong support group to help you through it will definitely help.

On cancer.

When my mother first mentioned that she had a lump in her breast, neither of us know what to expect. When she revealed that it had been there for over two years and was larger than when she initially found it, I urged her to immediately go to a doctor to get it examined. A month and a mammogram later, she was scheduled for a lumpectomy to get the mass in her breast removed. She was told not to worry and that she likely had precancerous cells that should be taken out “just in case”.

It turned out that the cells were in fact cancerous. After more diagnostic studies, it turned out that these cancerous cells had spread to the other breast as well.

Having just lost my grandmother to a brain tumor a couple of months prior, the diagnosis was very hard for me to accept. It felt like so much was out of my control. I wished that she knew to get help sooner. She said she never brought it up to her doctor because she didn’t feel comfortable talking about “those parts” with a male. She had no idea that not getting the lump in her breast checked out sooner could’ve prevented her from being diagnosed with breast cancer.

Even as an educated medical student, “cancer” is an incredibly scary word. It was even harder to use that word when talking about someone I loved. While my mother’s oncologist was very skilled, she was confined to her assembly-line medicine job’s regulations. She spent a half an hour explaining that my mother needed both of her breasts removed and left her with little explanation on what other interventions or steps my mother could take to eradicate her cancer. I felt like there had to be something other than surgery, chemotherapy, and conventional intervention to help my mother.

I was fortunate to meet Dr. Dawn Lemanne in Breitenbush hot springs. Dr. Lemanne told me about the field of integrative oncology and how there are other options for people like my mother. While the conventional interventions often provide a cure, there’s so much more traditional oncologists could be recommending. Dr. Lemanne told me about how nutrition and natural methods can play a huge role in fighting cancer.

I went back home full of excitement to be able to pass along specific dietary recommendations to my mother that I had learned from Dr. Lemanne. My mother was ecstatic to learn about what else she could be doing to take control of her cancer. She felt like she had control over her life again. She felt like she found new hope when she realized that she wasn’t relying solely on the surgery and chemotherapy. Having a natural way to supplement her treatment gave her power.

My call to action for everyone, medical or not, is to read the book that Dr. Lemanne c0-authored: n of 1. Almost everyone I know has had a family member or friend affected by cancer and this book provides more information on integrative oncology and the amazing effects it has had on curing a patient’s leukemia.

Words from my friend Dr. Dawn Lemanne, a stanford-trained board-certified medical oncologist & integrative oncologist who is self-employed at Oregon Integrative Oncology in Ashland, Oregon:

“My dream goal: integrative oncology IS the standard of care! Arrived home from a backwoods retreat hosted by Pamela Wible, MD, where I was given a power infusion by dozens of brilliant and brave physicians and healers. Home again. Waiting in the mailbox, my new book! Five years I spent writing it, and now it’s in my hands. My baby 🙂

Story: Harvard-documented “molecular” (i.e. REALLY complete) remission of chronic lymphocytic leukemia —- without conventional treatment.

Important because: conventional oncology calls this disease incurable and eventually terminal.

Translation: integrative was WAAAAYYYY better than conventional — for the specific patient here!

Result: Goal is closer: we ARE moving integrative oncology to the center of cancer care.

Book goes on sale Dec 27.

Read first 5 chapters free now: https://glennsabin.com

n of 1 is a rallying cry for patients, their physicians, and their loved ones to seek knowledge and self-empowerment–to fully understand their conditions and to treat their whole selves, not just their tumors. The book does not dismiss mainstream medicine, nor does it prescribe a diet, exercise regimen or supplement schedule that is appropriate for everyone. In fact, author Glenn Sabin embraces conventional oncology testing and effective therapies, in combination with integrative medicine.”

For more information on Dr. Lemanne’s practice where she focuses on combining lifestyle interventions with conventional cancer therapy please visit https://www.oregonio.com/

On assembly-line medicine.

To be totally honest, I wasn’t quite sure what osteopathic medicine was when I was applying to medical school.

I knew that osteopathic physicians had the same training and qualifications as their M.D. counterparts with some additional education in osteopathic manipulative medicine (OMT). When I started to research more into D.O. schools and what it meant to be an osteopathic physician, I was inspired. I loved how the osteopathic philosophy had a holistic approach to healing and understood the importance of the body’s innate ability to self-heal. I thought it was amazing that there was a whole group of physicians that believed in treating the body, mind, and spirit of each patient. For some reason, I had a belief that osteopathic physicians weren’t the type of people to work assembly-line physician jobs.

During my first couple of years at an osteopathic medical school, the inspiration continued. Though I never considered myself good at OMT, I loved working with my hands and having an extra tool to address somatic complaints. I practiced my skills outside of the second year lab on friends and family and felt rewarded when I resolved their neck pain or back pain. I started treating my own TMJ dysfunction with OMT and improved some jaw pain I was experiencing from stress-induced bruxism. OMT served as an exciting escape from the mundane pharmacology and microbiology facts we were forced to memorize. I couldn’t wait to see how OMT was being practically used in the clinics.

When I started rotations, I went to my first clinic full of excitement. I was finally going to see an osteopathic physician practicing in the way I hoped to one day… Or so I thought.

I saw a very different side of what I had imagined. My OB-Gyne preceptor spent about 5 minutes with each patient and saw an average of 50 patients during her clinic hours from 9am to 6pm. She often had to cut her appointments short or cancel them fully due to having to run to a delivery at the hospital nearby. Patient wait times ranged from 1 hour to 4 hours. Patients often had many questions about prenatal care and concerns about delivery planning that were not adequately addressed. The patients with chronic diseases often got education regarding their condition in the form of a handout and a short 1 sentence explanation.

Once I had improved my history and physical skills, I was allowed to admit a woman who was recently diagnosed with gestational diabetes. The pregnant patient was understandably concerned about the effect of medications and her uncontrolled blood sugars on her future child’s health. I spent 20 minutes talking about an ideal diabetic diet and the importance of exercise with her. When I walked out of the room, I was scolded by the medical assistant for spending too much time in the room which was needed for other patients. My preceptor told me that I should never be spending 5 minutes with each patient. “Prenatal care doesn’t require much. Just follow the protocols”, my attending physician said.

Instances like that happened often. I volunteered to do OMT on a patient who complained of a headache and was criticized again for spending too much time with the patient. I was offering something outside of the protocol, which seemed unheard of at this clinic. Patients who revealed their emotions often received a manufactured “Hang in there, it’ll be alright” from my attending physician and given a tissue while being escorted out of the exam room. It seemed that exam rooms were worth more for the revenue they could generate rather than the problems of patients they could fix inside of them.

I went home often feeling frustrated and defeated. My idea of what an osteopathic physician was so different than what I had experienced. I thought the benefit of attending an osteopathic versus allopathic medical school was to have mentors that treated patients holistically and addressed their complaints with new approaches. I thought that OMT was something that I would be allowed to perform at my rotation sites. I knew doctors did not have limitless time to spend with patients, but I thought they would be doing a better job of addressing psychosocial components to their conditions.

After some more insight into my OB-gyne preceptor’s corporate employer, I began to understand that she wasn’t practicing her idea of ideal medicine either. On a late night in between deliveries, she admitted to me that she was frustrated with her patient load but felt helpless. She didn’t have a choice rather than to stay in her assembly-line medicine job because of the medical school debt she was in. She was in a position where she had to rotate through patients daily, rather than spend quality time with them. She knew she wasn’t providing the best care to her patients as possible, but she felt stuck.

I left that rotation seriously questioning if medicine was the right path for me. I didn’t want to be in a practice like the one I had seen. I thought assembly-line medicine was the only option for me but I  knew wanted to have plenty of time with each patient and perform services outside of the protocol. I didn’t think that was still possible until I got involved in advocacy for the single-payer healthcare system in the US and the ideal medical care movement.

My call to action to people frustrated with the current state of the healthcare system is this: realize that you’re not alone. Assembly-line medicine is not the only option. I’m discovering daily that there are more and more people that are tired of medicine becoming a corporate entity and determining a physician’s every move. I realize that I can use my voice to make a difference and practice medicine in the way I had dreamed of.

For more information on single-payer check out my previous blog post and http://www.pnhp.org/facts/what-is-single-payer

For more information on the ideal medical care movement check out http://www.idealmedicalcare.org/

On competition.

Medical school attracts very similar kind of people. Most of us are high achieving, intelligent people with the common goal of helping others. It is beautiful to think of all of the potential patients we could serve working together. Applying to medical school and medical education often suppresses that potential.

Somewhere in between all of the courses one must take to enter medical school and the dreadful MCAT, it becomes a number game. I remember during my application process to medical school I started to think of myself in terms of my GPA and MCAT score. I started to look at potential places to learn in terms of whether or not I would be a competitive applicant. I realize now that I should have been evaluating if their philosophies aligned with mine.

Once in medical school, I continued the numbers game and kept thinking about how my exam scores weren’t as high as my classmates’ or how I wasn’t doing as many extracurricular activities as those around me. As medical students, we often worry about how we will appear to future residencies even if we’re years away from applying. Too often, we equate our self worth to our performance on standardized exams. We start comparing ourselves to classmates and others in medicine and kicking ourselves for not being as good.

During second year of medical school, I became closer to a group of classmates that supported each other and took away that feeling of competition. I began to realize again that we were all learning not to compete with one another, but to help our future patients. From study guides to late night calls, we helped one another realize that we weren’t alone. We created a support system that let go of all of the jealousy and competition. I will never forget feeling anxious before a microbiology exam and a classmate sitting with me for an hour before and calming me down when she could have been studying.

Not everyone in medical school is as fortunate as me to have a support system in their classmates. I have heard stories from my best friend who attends another medical school of how classmates often make each other look bad in front of attending physicians just to better their own name. Other friends in medicine have expressed their fears about talking about their test scores because they worried they would be looked down upon with jealousy for doing well.

My call to action to medical students everywhere is this: stop the competition. We all struggle with the same insecurities and should support one another rather than tear each other down. We can achieve a fostering and friendly culture in medical education if we let go of the competition and jealousy. We must start supporting each other through this malignant process. We are not defined by our CVs or test scores, but rather our desire to become healers.