Burnout

Taking care of ill patients exerts an enormous physical and emotional toll. Caregivers of all types—doctors, nurses, therapists, family members—are susceptible to these strains. But reactions to these stresses are different. Some caregivers possess large emotional reserve and strong support systems. Others become cynical or callous. Still others find that these stresses exacerbate underlying depression or drug and alcohol issues. For most caregivers, it is a complex combination of individual coping mechanisms and an evolution of our personalities—for better or worse.

In this video “Intensive Care,” I tell the story of a remarkable and brilliant physician who had a profound effect on me during my medical training. It is a true story, but the names have been changed.

The essay is from the book “Singular Intimacies: Becoming a Doctor at Bellevue” (Beacon Press). The reading was filmed at Baruch College.

Watch video here.

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Screening the Nurse: Call to Service

An exploration of nursing in the film collection of the Imperial War Museum

Saturday 27th and Sunday 28th February 2010, 10am-5.45pm

On the 27th-28th February the Florence Nightingale School of Nursing & Midwifery and curators from the Imperial War Museum will use film to celebrate and analyse nurses' contributions to war - from Florence Nightingale and Mary Seacole in the Crimean War to 21st century nursing in Iraq, via 20th century wars.

Modern professional nursing was born in the crucible of war. 2010 marks the 150th anniversary of the Nightingale Training School from which the Florence Nightingale School of Nursing and Midwifery at King's College London is descended. The School was funded by an outpouring of national thanksgiving for Florence Nightingale in the form of charitable donations, following her expedition to Turkey during the Crimean War.

Experts from the School and colleagues from Film Studies, War Studies and the Institute of Psychiatry at King's College London, together with the Museum's curators and guests from other universities, will introduce documentary, recruitment and feature films followed by question and answer sessions featuring panels of experts. A live musical accompaniment will provide a soundtrack to the silent films. Some of the films have never been screened to the public before.

Screening the Nurse: Call to Service is open to the public and entry is free. Admission is first come, first entry, and visitors may enter and exit between, but not during, sessions.

For the programme and more information see

http://london.iwm.org.uk/server/show/conEvent.3224

http://www.kcl.ac.uk/schools/nursing/events/other.html

Music in Medicine?

The holiday season is finally over. Not to be a complete Grinch, but I am more than happy to see all the tinsel and reindeer and artificial snow come down from the halls of our hospital. Whether all that holiday ornamentation actually belongs in a hospital is fodder for a difference essay, but the part that I’m most glad about is that the piped-in music has stopped.

Every morning, for two long months, when I slogged into the hospital to make rounds on my ill patients, I had to suffer the repeating loop of Christmas music on my way to the elevators. It’s not necessarily that I dislike holiday music—though these renditions were definitely not Grammy finalists—but that I didn’t want someone else’s music forced into my head.

Music is intensely personal. Unlike the art that adorns the hospital walls, which I am free to turn away from if I don’t like, the music was inescapable for the length of the hallway, which could feel interminable on the 57^th loop of “Jingle Bell Rock.”

Music has strong therapeutic qualities, as evinced by the growing number of music therapy programs in hospital settings. There’s even a scientific journal “Music and Medicine” devoted to scientific developments in musicology that affect patients.

But I wonder about the effects on the staff who are forced to listen to music that is not of their choice? I’m not sure about the rest of my colleagues, but I am horrifically susceptible to musical worms—the melodies that get stuck in your head and replay in perpetuity.

So, for the majority of the extended holiday season, I would round on my patients and review their medical conditions with “Deck the Halls with Boughs of Holly” as an underlying basso continuo. Some would say that this could be a good thing, but personally I felt hostage to these saccharine tunes.

When finally I turned in despair to my (Jewish) supervisor, he said confessed to me in a low voice: “Oh, this is my favorite time of year. The music in hall just makes me feel so happy.”

Maybe it is just personal taste, but to me music is too potent to squander with tinny Muzak forced on the unbidden masses. Here’s an essay I wrote on music and medicine that appeared in The Lancet, trying to reconcile my day-job as a physician and my after-hours gig as a struggling cello student. I’d appreciate your thoughts.

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Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Bryan Charnley

Bryan Charnley was an artist and schizophrenic patient, he started the 'Self Portraits Series' in 1991 and was encouraged by a friend to keep a diary that explained the imagery of the portraits. You could call it an experiment of sorts as the series openly describes the graded sufferings he was oppressed by, as he struggled with his medication (see the enclosed linked for more information). The portraits describe his paranoia, depression, and psychosis accurately.

Brian Charnley in March 1991 at the beginning of the series.

3 Months later


18th of May 1991


13th of June 1991

There was no commentary for the penultimate and final portraits which do not even have faces on them, but this 'map' shows very well the paranoia Charnley was facing as he feels surrounded by enemies, despite 'Hope' being at the centre.

This final portrait was left on the easel in his studio where he committed suicide shortly after painting it.

Writing About Patients: Is it Ethical?

There is a veritable epidemic of doctor-writers out there. What is going on?

Are doctors suddenly in the kiss-and-tell mode? What about confidentiality? Professionalism? HIPAA?

As one of the aforementioned doctor-writers, I look upon this trend with both awe and trepidation. I suspect that that this flourishing literary phenomenon relates to the public’s fascination and fear about all things medical. It also relates to the falling away of previous, pedestal-like images of doctors and doctoring. Lastly, it may have occurred to the medical profession—and this has taken a few centuries, it seems—that doctors have profound emotional reactions to the work we do, and that exploring these reactions may offer benefit to both patient and doctor.

Whatever the reason, this literary genre appears to be here to stay, and it is worth considering the ethical implications. Legally, there doesn’t appear to be much beyond protecting identity and avoiding libel.

But physicians clearly need to work with a higher bar. For starters, patients speak to doctors with an expectation of confidentiality. This is vastly different from an ordinary citizen speaking to a journalist. This confidentiality needs to be preserved. Unless a patient indicates otherwise, a doctor-writer must change the name and identifying characteristics. My rule of thumb is that the description must be different enough that it would be tough for anyone other than that person or a close associate to recognize them.

This, of course, brings up an issue of reliability. We’re trafficking in nonfiction, not fiction. When I write, I try to ensure that the aspects I change are not the crucial ones in the story. When talking about the intricacies of an illness, it probably doesn’t matter whether the hair is blond or brown, or the country of origin is Trinidad rather than Jamaica. If these minor things mask the patient’s identity without altering the key aspects of the story, then I think it is a reasonable trade-off.

But most importantly, there is the consideration that patients come to us for our help. They are in a particularly vulnerable situation and doctors have an ethical obligation to put that first. If, at some later time, this seems like a story that might edify the current discourse, the doctor might think about writing it up. It is helpful to let some time pass, so that the situation is no longer “active.” If it’s possible to obtain consent, we should do so.

If I can’t obtain consent, then I need to ask myself whether I feel the patient might be hurt by the publication of the story. If there’s any thought that this person would be uncomfortable or embarrassed or pained, then the story stays in the drawer, no matter how amazing it is. (I have one powerful story—about a patient lied to me, and the implications of that lie—but I suspect that my patient would be unhappy if he ever saw the story, so I’ve never pursued publication.)

Ultimately, I want to give a respectful rendering of my patient’s story, one that I hope would honor them and what they’ve endured. Of course this is necessarily a subjective decision, but it is the only internal ethic that I can live with. My patients have entrusted me with their stories, and I need to respect that. If a particular story can edify future doctors, or educate the public, there might be value in publishing it.

I choose these stories very carefully. I obtain consent when possible—patients almost always have a positive reaction. I let time pass. I try my best to write a story that honors them, and show a draft to them if circumstances permit.

Ultimately, doctor-writers have to treat patients’ stories as we treat our patients, realizing that we are in a privilege position, and taking care not to abuse that.

(Read more about the ethics of doctors writing in Danielle Ofri’s essay in The Lancet.)

Danielle Ofri is a writer and practicing internist at New York City’s Bellevue Hospital. She is the editor-in-chief of the Bellevue Literary Review. Her newest book is Medicine in Translation: Journeys with my Patients. View the YouTube book trailer.

You can follow Danielle on Twitter and Facebook, or visit her homepage.

Her blog, Medicine in Translation, appears on Psychology Today’s website.

Portraits, Patients and Psychiatrists

Last week I attended a very interesting seminar at King's College London's new Centre for the Humanities and Health. Artist Gemma Anderson and psychiatrist Tim McInerny have collaborated on a project called 'Portraits: Patients and Psychiatrists'. Dr McInerny, a forensic psychiatrist working at Broadmoor, was inspired by seeing Gemma's etchings at the RCA's graduate show. He felt that they had parallels with psychiatry in that they gave an insight into the personalities of her sitters. They decided to collaborate on a series of portraits of psychiatrists and their patients, supported by a Wellcome Trust Arts Award.

The portraits are deliberately ambiguous -- doctor and patient are not immediately discernable. One of the strengths of the project is that it honours both sitters as individuals, rather than highlighting the differences in status between them.

Gemma works from life on a large wax tablet. She gets to know her sitters, finding out what interests them. She then incorporates imagery from their narraties into the portrait, often drawing from natural history museum collections. The portraits reminded me of frontispieces to 18th century books -- full of symbolism and 'emblems'.

Because anonymity needs to be respected, the line-drawing nature of the etchings is ideal. There is not too much facial detail, but each is still recognisable as a portrait. Gemma stressed that she was not trying to capture the entire life story of her subjects, although this informs her work. The portraits are her interpretations, rather than a transcription of her sitters' stories. She did not seek 'approval' from the sitters about what to include.

Dr McInerny explained that the patients and the doctors enjoyed having their portraits made. The natural imagery and the sense of calm that pervades the portraits serves as a counterbalance to the often very negative imagery that abounds about psychiatric patients in the press. Of course, it is tempting to focus on the patients' portraits because their life stories have had such a profound influence on their circumstances, but this is also true of the doctors who treat them. The portraits remind us that there is more to the personality than the sum of our personal or profession actions.

You can read more about the project and find out about the fascinating working methods employed in making the etchings on Gemma's blog.

Hippocrates poetry prize -- deadline extended

The deadline for the Hippocrates Prize for Poetry and Medicine has been extended to 15 February. The prize will be announced at the splendid sounding 2010 International Symposium on Poetry and Medicine being held in Warwick on 10 April.

8.45am Registration
9.25am Symposium start
5pm Close of Symposium followed by a reception for speakers, delegates and Hippocrates Prize winners.

Symposium speakers will include: Peter Goldsworthy Poet and medical practitioner, Australia Michael Hulse Editor, The Warwick Review

Symposium topics will include: poetry in medical settings (oncology, cardiovascular disorders, childhood illness ...); doctor poets (Gottfried Benn, William Carlos Williams); poetry in the consultation; creative health professionals; medical inspirations for poetry (anatomy; poisoning in Shakespeare's writings ...).

Call for papers
Submissions are welcome for the Symposium as posters for discussion or short oral communications. Email the Symposium Office to express interest in submitting a Symposium Abstract. Closing date for Symposium Abstract submission has been brought forward to 6pm Friday 19th February 2010.

Key themes will include:history of interactions between medicine, health and poetry; impact of health and disease on the writings of the professional poet; poetry as therapy; the nature of the body, and anatomy; the history, evolution, current and future state of medical science; the nature and experience of tests; the experience of doctors, nurses and other staff in hospitals and in the community; the experience of patients, families, friends and carers in these situations; the experiences of acute and long-term illness and dying, of birth, of cure and convalescence; the patient journey; the nature and experience of treatment with herbs, chemicals and devices used in medicine.

The Symposium is being held on the awards day for the 2010 International Hippocrates Prize for poetry and medicine.

2010 Hippocrates Prize - Closing deadline 12 midnight GMT Monday 15th February. The 2010 Hippocrates Prize awards will be announced at the Symposium. There is a £15,000 award fund for the prizes, which will be given in an ‘open’ category which anyone can enter and in an ‘NHS’ category open to National Health Service employees and health students. The first prize for the winning poem in each category is £5,000.

Broadcaster, journalist and writer James Naughtie are joining NHS Medical Director Professor Sir Bruce Keogh and poet and Doctor Dannie Abse as judges of this new pair of national and international medical poetry awards.

The 2010 Hippocrates Prize is being organised by a joint team from the University of Warwick’s Department of English and Comparative Literary Studies and the University’s Medical School.

The International Poetry and Medicine Symposium and the 2010 Hippocrates Prize are supported by the Institute of Advanced Study at the University of Warwick and by the national Fellowship of Postgraduate Medicine.