Sunday, March 29, 2015

Medical Students, Physicians, Bullying

The difficulties facing medical students and physicians are diverse and persistent. There is no escape from basic human tendencies. The competitive, critical disputatious nature of humans is amplified in medical institutions, despite a superficial appeal to collegiality. Physicians often face moral dilemmas and must cope with the least pleasant aspects of the human experience, often with little or no support from colleagues.

As most medical care becomes concentrated in large, impersonal institutions, a sense of alienation prevails. A pamphlet from the Canadian Medical Association for physicians talks about the “impact of stress on physician health and well being.” Canadian physicians are generally unhappy about the increasing demands on their time and energy while resources and rewards are shrinking. In Canada, physicians work in a government under-funded system that survives on budget cuts and rationing services.

The CMA pamphlet begins with a fuzzy statement that could win a prize in the annals of obfuscation: “Stress is part of everyone’s life. A certain level of stress contributes to optimal performance. However, when it is not managed properly, stress can become overwhelming, leading to physical, mental and spiritual difficulties.”

 I acknowledge that some readers would be more receptive to this kind of talk than I am. However, I would want them to ask what is really going on here? Physicians get tired, discouraged, frustrated and become angry like all other humans. Physicians tend to be more tolerant and giving than most other humans, but each person has limited understanding and limited resources. When demand exceeds supply, physicians, like other people, get discouraged, tired and angry. They may feel and act badly in a variety of ways. If we really want to understand the plight of physicians, the first step would be to pledge never to use the word “stress” just as we have pledged never to use the word “psychological” or the word “spiritual.” These are nonsense words that obscure what is really going on.

Dr. Pamela L. Wible wrote about physicians' bullying medical students and each other. Increasing concerns about physician burnout and suicide have surfaced in the US. Medical students suffer bullying and some end their lives. Wiebe stated: "The truth is, doctors are suffering. Surrounded by sickness and death, we watch families wail, shriek, cry while we stand silently—sacred witness to their sorrow—until we're called to the next room for a heart attack, a gunshot wound, a stillborn. Week by week. Year by year. And when do we grieve? Never. Doctors are not allowed to grieve. Today a physician tells me she's been cited for unprofessional conduct. Why? She was seen crying. Her boss told her, "Unless you are dying, crying is unprofessional behavior and not to be tolerated." Doctors are not allowed to cry. So, what do we do with our sadness? We injure ourselves—and each other. When I speak to victims of physician bullying, I explain, "Your instructors are suffering from unprocessed grief—probably victims of bullying themselves. Medicine is an apprenticeship profession. Trained by wounded doctors, they're now wounding you. Your bright eyes, your enthusiasm, your idealism remind them of their loss. Rather than feel their own grief, they lash out at you." (Pamela L. Wible. Physician Bullying: 'Not Allowed to Cry'. Medscape. Feb 20, 2015.)

There are few physicians who would not respond well to expressions of gratitude, respect and tender loving care. Each one needs more time off and an assistant or two to do all the extra chores demanded of them. Physicians spend much of their time caring for others but seldom receive care themselves. The increasing tendency for hospital and government administrators is to treat physicians with disrespect and to blame them for the high cost of medical care. Physicians confront injury, disease, cruelty, ignorance and anger most days and often miss opportunities to celebrate the joyful, creative aspects of life. A basic imbalance for any human is receiving less than he or she is giving. Physicians become overtired, do not eat well or regularly and often fail to enjoy friendly and affectionate leisure time with family and friends…. our description can go on and on. The more we observe specific details of physicians lives (never using the term “stress”) the more we understand how these humans suffer, make mistakes, become dysfunctional and ill or, if they are smart, take a long vacation or quit medicine before they collapse from frustration, disillusionment and fatigue.

See Medical Care Perspectives

Monday, March 02, 2015

Drinking Alcoholic Beverages

The Problem is drinking too much of the wrong drinks

The Solution : Stop Drinking Alcoholic Beverages

Humans like to become intoxicated. Fermented, liquid foods that contain alcohol are used worldwide in parties, celebrations and rituals. It is common for fermented foods to be included in the daily diet. Small doses of fermented foods relax inhibitions and can feel pleasant in social situations. Larger doses are toxic to the brain and disable the drinker.  The regular abuse of alcoholic beverages is called "alcoholism. The stigma  attached to the term "alcoholism" remains an obstacle to understanding this common problem.

There is a tendency to deny or to "normalize" excessive drinking. The use of alcoholic beverages is woven into the fabric of society and excessive use of alcohol is often considered "normal"  Regular ingestion of alcoholic beverage in excess produces many disease patterns involving every part of the body. Even “moderate” alcohol abuse distorts the personality, emotions and intellect of the "social drinker." The cognitive impairments and personality distortion are a direct consequence of brain dysfunction cause by ethanol and other chemical pathogens in alcoholic beverages.  Alcohol abuse is considered to be an addiction and some argue about calling alcoholism a “disease.” The term “addiction” refers both the compulsive aspect of drinking and also to the harm drinking causes. The drinker harms himself, his family and the community at large. A reasonable person will notice the harm he or she is causing and will seek to remedy the problem. An addict ignores the harm and remains devoted to ingesting alcoholic beverages no matter how much harm is caused.

Intoxication with alcoholic beverages generates behaviors that are regrettable and often destructive. Drunk people do much harm to themselves and others. The main drug effect is exerted by ethanol on the brain. As blood levels of ethanol increase, more and more brain functions are shut-down, rendering the intoxicant temporarily demented, with inappropriate behavior, incoordination and poor judgment. Alcohol intoxication routinely promotes fighting, assaults and death by accident or murder.

Dr. Gislason states in his preface to the book, Alcohol Problems and Solutions:

"I have learned that humans generally do things that they should stop doing. In addition, I have learned that reasonable, rational solutions to human problems are seldom pursued for very long. Alcohol abuse is one of the common human aberrations that has an easy, rational solution --- stop drinking. But drinkers routinely avoid the easy, rational path to health and happiness and instead pursue a self-destructive course that causes much harm and great human misery. This is a curious feature of the human mind that requires explanation.

Dr. Sidney Cohen, a drug abuse expert, described alcohol as "the most dangerous drug on earth." There are a variety of drinking patterns and the range of injury among alcohol abusers is great. Some are mildly injured and can recover on their own with the right tools and techniques. Others are critically injured, need hospitalization and prolonged rehabilitation with custodian supervision.  The challenge to a heavy drinker is not just to stop drinking for a while, but to stop forever.

Alcoholism is a complex and diverse problem. My book attempts to understand the problem of alcoholism and points to a comprehensive solution that requires alcohol abstinence and diet revision along with moral and mental resolve to restore a sane, sensible way of living. "

From the Book "Alcohol Problems and Solutions by Stephen Gislason MD